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June 26March 20May 5, 2020
Medicaid Analytics Performance Portal Health Home Tracking System
File Specifications Document
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Table of Contents Introduction .................................................................................................................................................. 7
Version Update ......................................................................................................................................... 7
Purpose and Overview .............................................................................................................................. 7
MAPP HHTS Access ................................................................................................................................... 8
Additional Information.............................................................................................................................. 9
Brief Description of Files Available ........................................................................................................... 9
Assignment Files ......................................................................................................................................... 13
Managed Care Plan Assignment File ....................................................................................................... 15
Description .......................................................................................................................................... 15
Format ................................................................................................................................................. 15
Editing Logic ........................................................................................................................................ 20
Child Referral Download File .................................................................................................................. 24
Description .......................................................................................................................................... 24
Format ......................................................................................................................................... 252524
Editing Logic ........................................................................................................................................ 26
Managed Care Plan Final Health Home Assignment File ........................................................................ 27
Description .......................................................................................................................................... 27
Format ................................................................................................................................................. 27
Editing Logic ................................................................................................................................ 282827
Error Report: Managed Care Plan Final Health Home Assignment File .................................................. 30
Description .......................................................................................................................................... 30
Format ................................................................................................................................................. 30
Editing Logic ........................................................................................................................................ 30
Health Home Assignment File ................................................................................................................. 30
Description .......................................................................................................................................... 30
Format ................................................................................................................................................. 31
Editing Logic ........................................................................................................................................ 35
Past Assignments .................................................................................................................................... 39
Description .......................................................................................................................................... 39
Format ................................................................................................................................................. 40
Editing Logic ........................................................................................................................................ 40
Program Participation Files ......................................................................................................................... 42
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Program Participation Upload File .......................................................................................................... 42
Description .......................................................................................................................................... 42
Format ................................................................................................................................................. 42
Editing Logic ........................................................................................................................................ 42
Program Participation Error Report ........................................................................................................ 43
Description .......................................................................................................................................... 43
Format ................................................................................................................................................. 43
Editing Logic ........................................................................................................................................ 43
Program Participation Download File ..................................................................................................... 43
Description .......................................................................................................................................... 43
Format ................................................................................................................................................. 43
Editing Logic ........................................................................................................................................ 44
Consent Files ............................................................................................................................................... 44
Consent Upload File ................................................................................................................................ 44
Description .......................................................................................................................................... 44
Format ......................................................................................................................................... 454544
Editing Logic ........................................................................................................................................ 45
Consent Error File ........................................................................................................................... 474746
Description .................................................................................................................................. 474746
Format ................................................................................................................................................. 47
Editing Logic ........................................................................................................................................ 47
Consent Download File ........................................................................................................................... 47
Description .......................................................................................................................................... 47
Format ................................................................................................................................................. 48
Editing Logic ........................................................................................................................................ 48
Tracking File Records .................................................................................................................................. 49
Tracking File Assignment Records ........................................................................................................... 50
Description .......................................................................................................................................... 50
Format ................................................................................................................................................. 50
Editing Logic ........................................................................................................................................ 51
Tracking File Segment Records ............................................................................................................... 55
Description .......................................................................................................................................... 55
Format ................................................................................................................................................. 55
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Editing Logic ........................................................................................................................................ 56
Tracking File Delete Records ................................................................................................................... 62
Description .......................................................................................................................................... 62
Format ................................................................................................................................................. 63
Editing Logic ........................................................................................................................................ 63
Tracking File Error Report ....................................................................................................................... 63
Description .......................................................................................................................................... 63
Format ................................................................................................................................................. 63
Editing Logic ........................................................................................................................................ 64
Member Downloads ................................................................................................................................... 64
Enrollment Download File....................................................................................................................... 64
Description .......................................................................................................................................... 64
Format ................................................................................................................................................. 65
Editing Logic ........................................................................................................................................ 66
Members Download File ......................................................................................................................... 67
Description .......................................................................................................................................... 67
Format ................................................................................................................................................. 67
Editing Logic ........................................................................................................................................ 69
Manage Assignments Download File ...................................................................................................... 72
Description .......................................................................................................................................... 72
Format ................................................................................................................................................. 72
CIN Search Download File ....................................................................................................................... 72
Description .......................................................................................................................................... 72
Format ................................................................................................................................................. 72
Editing Logic ........................................................................................................................................ 76
Assessment Download File ..................................................................................................................... 76
Description .......................................................................................................................................... 76
Format ................................................................................................................................................. 76
Editing Logic ........................................................................................................................................ 76
Billing Support ............................................................................................................................................. 77
Billing Support Upload File ...................................................................................................................... 78
Description .......................................................................................................................................... 78
Format ......................................................................................................................................... 797978
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Editing Logic ................................................................................................................................ 808079
Billing Support Error File ................................................................................................................. 838382
Description .................................................................................................................................. 838382
Format ................................................................................................................................................. 83
Billing Support Download File ............................................................................................................. 8483
Description ...................................................................................................................................... 8483
Format ............................................................................................................................................. 8786
Editing Logic ........................................................................................................................................ 90
Provider Files ........................................................................................................................................... 9493
Partner Network File Upload .............................................................................................................. 9493
Description ...................................................................................................................................... 9493
Format ................................................................................................................................................. 94
Partner Network File Error Report .................................................................................................. 959594
Description .................................................................................................................................. 959594
Format ......................................................................................................................................... 959594
Editing Logic ........................................................................................................................................ 95
Partner Network File Download ......................................................................................................... 9695
Description ...................................................................................................................................... 9695
Format ............................................................................................................................................. 9695
Editing Logic ........................................................................................................................................ 96
Provider Relationship Download File .................................................................................................. 9796
Description ...................................................................................................................................... 9796
Format ............................................................................................................................................. 9796
Editing Logic ................................................................................................................................ 979796
Appendix A: Field Descriptions .......................................................................................................... 999998
Appendix B: File Error Reason Codes ........................................................................................... 159159158
Appendix C: Segment Pend Reason Codes .................................................................................. 170170168
Appendix D: Segment End Date Reason Codes ........................................................................... 171171169
Appendix E: Assignment Rejection Codes .................................................................................... 173173171
Appendix F: Assignment Pend Reason Codes .............................................................................. 174174172
Appendix G: Assignment End Reason Codes ............................................................................... 175175173
Appendix H: High, Medium, Low (HML) Assessment Codes ....................................................... 179179177
Appendix I: Tracking File Record Type Codes .............................................................................. 182182180
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Appendix J: Determining the Billing Entity .................................................................................. 183183181
Appendix K: MCP Final H Assignment File Accepted Values ....................................................... 184184182
Appendix L: Reference and Contacts ........................................................................................... 186186184
Appendix M: Consent File Codes .................................................................................................. 188188186
Appendix N: Program Participation File Codes ........................................................................... 189189187
Appendix O: Transfer Reason Codes ............................................................................................ 190190188
Appendix P: Billing Instance Validation Codes ............................................................................ 191191189
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Introduction
Version Update Version 3.0 and higher of the file Specifications removed references to historical use and changes of the MAPP
HHTS file specifications and include the current functionality and usage of the specifications as of the most recent
release date. Version logs and previous file specifications version are available in the archived section of the MAPP
HHTS website for reference:
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/mapp/index.htm
Purpose and Overview
The purpose of the Medicaid Analytics Performance Portal (MAPP) Health Home Tracking System (HHTS) File
Specifications Document is to explain how the MAPP HHTS files interact with the MAPP HHTS, including field
definitions and code descriptions.
Throughout this document, the Medicaid Analytics Performance Portal Health Home Tracking System (MAPP
HHTS) will be referred to as the system. The terms The New York State Department of Health, Managed Care Plan,
Health Home, and Care Management Agency will be referred to as DOH, MCP, HH, and CMA respectively. Also,
individuals associated with MCPs, HHs, CMAs, and other organizations accessing the MAPP HHTS will be referred
to as users.
Within the system, almost all actions can be performed through three different methods:
1) Individual online – performing actions for an individual member online one at a time.
2) Bulk online - using online filters to define a group of members and performing an action on that group of
defined members online.
3) File Transfer – performing actions by uploading and downloading files.
The purpose of the MAPP HHTS File Specifications Document is to explain how system actions are performed
using the file transfer method only, meaning that this document does not account for the other methods that
can be used to perform actions within the system. While users can use a combination of methods when
performing actions within the system, this document assumes that a user is only using the file upload method.
For example, this document will state that a user must upload a certain file in order to complete a required
action. Such a statement is meant to clarify to a user how a specific action is performed using the file transfer
method, not to imply that a user can only use the file transfer method to perform the action within the system.
This document does not explain how a user navigates to the MAPP HHTS nor how a user uploads a file to or
downloads a file from the system. Users learn how to navigate to the system and how to use all three methods
during MAPP HHTS web-based trainings. Please contact MAPP Customer Care Center (MAPP CCC – see Appendix
L: Reference and Contacts) to request information on accessing existing training documents or web-based
trainings.
This document includes the basic file formats that are listed on the Health Home website under Tracking System
File Formats as “MAPP HHTS File Specifications v10.0”:
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/mapp/index.htm
The file format tables included in this document may contain two columns that do not appear on the file format
excel spreadsheet.
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The first one is the “Required” column containing values of ‘Y’ – yes, ‘N’-no, or ‘C’-conditional.
1. A value of ‘Y’ – yes, means that the field is required on the upload file and that records that do not contain an
acceptable value in that field will be rejected. On a download file, a value of ‘Y’ means that the field will
always be populated.
2. A value of ‘N’ – no, means that the field is not required on an upload file; records that do not have a value in
these fields will be accepted. However, if a non-required field contains a value, then that submitted value
must conform to any editing logic applied to the field or the record will be rejected. On a download file, a
value of ‘N’ means that the field may not be populated if the user who uploaded the file didn’t populate
the field.
3. A value of ‘C’ – conditional, means that the field is required, but only in certain situations (usually because a
related field contains a value that requires additional information).
The second column not in the format tables is “Source”. This column indicates where data originated from. The
table below explains what each column value means.
Source Source Description M'caid Provided by official NYS Medicaid information
Gen Generated by the system based on information in the system about the record (member's HML rate would be marked as ‘Gen’ since it is determined by the system using the member’s monthly HML response and other information available in the system)
MCP Submitted by Managed Care Plans
MCP/HH Submitted by Managed Care Plans or Health Homes
HH Submitted by Health Homes
CMA Submitted by Care Management Agencies
HH/CMA Submitted by Health Homes or Care Management Agencies
Ent'd Displays on error report, a concatenation of the information originally submitted on the rejected record
DOH/MCP Submitted by the DOH Health Home Team or Managed Care Plans
User Submitted by Managed Care Plans, Health Homes, Care Management Agencies, or other user
MAPP HHTS Access
The MAPP HHTS is a sub-section of the NYS DOH MAPP application, which is housed within the Health Commerce
System (HCS). The MAPP HHTS is the system of record for the Health Home program.
Each MCP, DOH designated HH with a completed DUA with DOH, and CMA that has a completed DOH approved
BAA with a designated HH can access the system. LGU/SPOA and LDSS organizations also access the MAPP HHTS.
Each provider ID that has access to the system has at least one user that is setup within the system with the
gatekeeper (or admin) role. Individuals set up with the gatekeeper role within the system are responsible for
setting up appropriate users from their organizations as MAPP HHTS users. All MCP, HH and CMA users must have
an active HCS account and will be set up by their organization’s gatekeeper under one or more of the following
user roles: worker, read only, gatekeeper, referrer or screener. Worker and read only users are able to download
the files discussed within this manual, but only workers can upload files into the system. Referrer roles do not
have access to view, upload or download files.
For more information on gaining access to the MAPP HHTS, please see Appendix L: Reference and Contacts.
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Additional Information
The files described in this document are organized into sub-sections based on the types of functions performed by
each grouping of files. Each file in a sub-section contains a description, a file format table, and an editing logic
section that explain respectively what functions that file performs, how the file is organized, and any editing that
applies to the file.
Additionally, this document contains an extensive set of Appendices, which include field descriptions, code lists,
and Health Home reference information. Please see Appendix A: Field Descriptions for detailed descriptions of
accepted field values, field descriptions, and additional information on how fields are populated and edited.
Each file downloaded from the system is a “point in time” full file replacement snap shot of member statuses as
of the moment that the file is requested. Once a file is downloaded, the data included in the downloaded file have
the potential to change, so providers that are using their own system to track Health Home members should
upload and download files as often as possible. Each file description section indicates how often a provider is
required to upload/download the file in addition to suggested “best practices” for uploading/downloading files,
where applicable.
Lastly, all files can be uploaded into the system or downloaded from the system in either .csv or .txt (fixed length
text file) format. When using fixed length text file format, special characters are disallowed in the file upload
record. When using the comma delimited file format, a comma is necessary to represent the boundary between
multiple fields but should not be used within a field. Additionally, all other special characters are disallowed in the
file upload record.
However, error files will only be available in the format of the corresponding uploaded file (e.g. if you upload a .txt
Billing Support Upload file, then your corresponding error file will be in .txt; if you upload a .csv tracking file, then
your corresponding error file will be in .csv). Files uploaded into the system do not need a header row. We do,
however, suggest you include header in .csv uploads to avoid file issues; if you include headers on a file upload,
expect the first row containing the header information to be rejected.
Files can also be zipped prior to download. A zipped will be downloaded in either a .csv or .txt format.
File Changes have been archived on the website and this document reflects the system as it is currently
implemented.
Brief Description of Files Available
File Who Can
Download Who Can Upload Description
Managed Care Plan Assignment File MCP This file is only accessible by MCP users and is
comprised of plan enrolled members that do
not have an open segment (not closed or
canceled) that are currently assigned or
referred to the user’s MCP in either an active,
pending, or pended MCP assignment status.
Child Referral Download File MCP, HH,
CMA
This file contains information collected about
a member that has an active, pending or
pended assignment (no active segment) with
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File Who Can
Download Who Can Upload Description
the downloading provider that was entered
into the MAPP HHTS through the Children’s
HH Referral Portal.
Managed Care Plan Final Health Home
Assignment File
MCP This file is only uploaded by MCP users and is
used to assign a current plan member to a
HH, to pend MCP Assignments, and to upload
plan supplied member information such as
language, updated demographic information,
and optimization information.
Error Report: Managed Care Plan Final Health
Home Assignment File
MCP This file is created upon validating or
processing an MCP Final HH Assignment file
containing at least one error.
Health Home Assignment File HH, CMA This file is accessible by both HH and CMA
users and is comprised of members that are
currently assigned/referred to the user’s
organization in either an active or pending
assignment status with the downloading
provider, but do not have an outreach or
enrollment segment in any status, except
closed or cancelled. The Assignment file also
contains information on pending and rejected
transfers.
Past Assignments MCP, HH,
CMA
The Past Assignments file includes members
who were assigned to the downloading user’s
organization but whose assignments with the
user’s organization were ended/rejected
without resulting in segments within the last
year.
Consent Upload File HH, CMA HH/CMA users upload this file to ‘C’ create,
‘M’ modify, and ‘W’ withdraw consent for all
members, regardless of age. This file is also
used to ‘P’ create Plan of Care records.
Consent Error File HH, CMA This file is created upon validating or
processing a Consent Upload file containing
at least one error.
Consent Download File MCP, HH,
CMA
This file contains all consent records and plan
of care records with an active, withdrawn, or
ended Consent Status for a provider’s
members.
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File Who Can
Download Who Can Upload Description
Tracking File Assignment Records HH, CMA HHs use this file to accept, reject, and end
member assignments; to create assignments
for their CMAs; and to accept, reject, and end
member assignments on behalf of their
CMAs.
Tracking File Segment Records HH, CMA HHs use this file to create, modify, pend, or
accept outreach and enrollment segments
and CMAs use this file to create, modify, or
pend outreach and enrollment segments. This
file is also used to create and accept pending
transfers.
Tracking File Delete Records HH, CMA The delete record is used to delete from the
system an incorrectly entered outreach or
enrollment segment and pending transfer
requests.
Tracking File Error Report HH, CMA This file is created upon validating or
processing a Tracking File Assignment
Records, Tracking File Segment Records, or a
Tracking File Delete Records file containing at
least one error.
Enrollment Download File MCP, HH,
CMA
The Enrollment Download file contains a
record for every outreach and enrollment
segment connected to the downloading
provider in the system in the following
statuses: active, closed, canceled, hiatus,
pended, pending active, pending closed,
pending pended, and pending canceled.
My Members Download File MCP, HH,
CMA
This file is downloaded from the My
Members screen, which displays members
that have an outreach/enrollment segment in
any status, except for canceled, with the
user’s provider in addition to members that
have an active, pending, or pended
assignment with the user’s provider.
Manage Assignments Download File MCP, HH,
CMA
This file is downloaded by a user from the
online Manage Assignments screen, which
displays the members that have a pended or
pending assignment/ transfer with the user’s
organization.
CIN Search Download File MCP, HH,
CMA
This file is downloaded by a user from the
Member CIN Search screen, which is
accessible by all users in the system and
allows a user to look up either an individual
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File Who Can
Download Who Can Upload Description
member or a group of members using a
member’s CIN.
Billing Support Upload File CMA, HH The purpose of the Billing Support Upload file
is for a user to 1) indicate whether or not a
billable service was provided for a billing
instance service date or to void a previously
added billing instance submission, and 2) to
submit member information needed to
support a Health Home claim for members
that received a billable service.
Billing Support Error File HH, CMA This file is created upon validating or
processing a Billing Support Upload file
containing at least one error.
Billing Support Download File MCP, HH,
CMA
The purpose of the Billing Support Download
file is to provide MCPs, HHs, and CMAs with
monthly billing information for members that
they are associated with in the MAPP HHTS.
Partner Network File Upload HHs HHs use this file to submit to the system their
network of providers.
Partner Network File Error Report HHs This file is created upon validating or
processing a Partner Network File Upload file
containing at least one error.
Partner Network File Download HH, CMA This file contains the information submitted
into the system by an HH user on the Partner
Network File Upload file, in addition to a few
fields added to the file by DOH to provide
official NYS Medicaid information regarding
the provider, if applicable.
Assessments Download File MCP, HH,
CMA
This file contains the children’s HCBS
assessment information and CANs-NY
assessment information for assessments that
have been signed and finalized in UAS.
Program Participation Upload File MCP, HH,
CMA
Users upload this file to create, end, or
cancel an opt-out record for a member
for whom they have a signed opt out
form. An MCP user can submit
information for any member associated
with the user’s MCP. HH and CMA users
can submit information for any member
with a valid Medicaid ID regardless of the
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File Who Can
Download Who Can Upload Description
member’s association with the uploading
user’s organization in MAPP HHTS.
Program Participation Error Report MCP, HH,
CMA
This file is created upon validating or
processing a Program Participation file
containing at least one error.
Program Participation Download File MCP, HH,
CMA
An MCP user will be able to view all
members associated with the user’s MCP
in MDW when downloading this file.
HH/CMA users will see members that
have an HH/CMA assignment that
overlaps the opt-out period as well as
members that have had an opt-out
record submitted from the downloading
organization.
Provider Relationship Download File MCP, HH,
CMA
A MCP, HH, or DOH will be able to
download this file and see all of the
provider relationships that they have
presently or in the past.
Provider Active User Download MCP, HH,
CMA
An MCP, HH or CMA user will be able to
download this file and see all the active
users assigned to associated with their
organization.
Assignment Files The following section provides a brief explanation of how Health Home eligible members are identified; assigned
to MCPs, HHs, and CMAs; and moved through the Health Home assignment statuses within the system using files.
Each member has a distinct assignment status with the provider(s) that the member is associated with through an
assignment.
The assignment process begins when a straight referral is made (the referring provider does not put the member
directly into an outreach or enrollment segment), which creates pending assignments/referrals with the members’
MCPs (or HH for FFS members). An MCP can then either accept a member in a pending MCP assignment/referral
status, meaning that the plan agrees to assign the member to a HH, or the plan can pend the pending
assignment/referral, meaning that the MCP is choosing not to act on the member’s potential HH eligible status. An
MCP would pend an assignment/referral when the MCP knows that the member is either not eligible or not
appropriate for the Health Home program or if there is not an appropriate HH assignment currently available for
the member. Once an MCP accepts a pending assignment/referral, the member’s pending MCP
assignment/referral moves to an active MCP assignment/referral status. An MCP can indicate that a pending MCP
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assignment/referral is accepted and move it to an active status by either accepting the pending
assignment/referral or by the MCP assigning the member with a pending MCP assignment/referral directly to a HH,
which automatically moves that member from a pending to an active MCP assignment/referral status and creates
a new pending HH assignment status.
From there, HHs access their members with a pending HH assignment status, both fee for service members directly
referred into the system and plan members assigned to the HH by the members’ MCPs. The HH can either accept
a pending HH assignment/referral, meaning that the HH agrees to assign the member to a CMA, or can reject the
pending assignment/referral, meaning that the HH does not accept the assignment. An MCP member assignment
rejected by the HH is returned to the member’s MCP and a FFS member assignment/referral that is rejected by the
HH is returned to DOH for reassignment. An HH can move a member from a pending HH assignment/referral to an
active HH assignment/referral by either accepting the pending HH assignment/referral or by assigning a member
with a pending HH assignment/referral to a CMA, which will automatically move the member to an active HH
assignment/referral and create a pending assignment with the CMA. Additionally, when an HH creates a segment
for a member with a pending HH assignment/referral, the system automatically moves the member’s
corresponding HH assignment status from pending to active and marks it as non-reportable (see last paragraph of
this section for more information on non-reportable assignments).
From there, CMAs access both fee for service and plan enrolled members assigned to them in a pending CMA
assignment status. The CMA can either accept the pending CMA assignment, meaning that the CMA agrees to
start outreaching to the member, or the CMA can reject the pending CMA assignment, which sends the member
back to the HH for reassignment. Additionally, if a HH or CMA creates a segment for a member with a pending
CMA assignment, then the system will automatically move the member’s assignment status from pending to
active. HHs are able to act on behalf of their CMAs.
While a member in an open outreach or enrollment segment is no longer included in a provider’s assignment file in
the system, the member’s assignments do not go away. A member in an outreach or enrollment segment will
always have an active “behind the scenes” assignment with the HH and CMA that the member has a segment with.
These “behind the scenes” assignments are called non-reportable and are not visible to users within the system. A
member enrolled with a plan in outreach or enrollment will always have an active assignment with that MCP listed
within the system. However, the assignment files downloaded from the system only contain members that do not
currently have an open outreach or enrollment segment and that have an active, pending, or pended assignment
with the downloading provider as of the date of the download. This means that while an MCP member with an
open segment will have an active MCP assignment within the system on the member’s assignment tab, that
member with the open segment will not be included on the MCP’s assignment file.
Since a member’s Medicaid and Health Home status can change at any time, assignment files should be
downloaded daily and MUST be downloaded at least once a week.
As of 11/22/19 assignments that have been sitting with an MCP, HH or CMA for 90 days or longer will be ended
and therefor removed from assignment files. Going forward, any member that has had no assignment or segment
action in the last 90 days will be ended. This is a change from the previous purge logic, which removed an adult
after 180 days and a child after 365 days. The purpose of this purge logic is to remove members that were known
to the system but were not effectively connected to the program. Any member that has been removed from
assignment files can be referred back into the program if appropriate. Members with a pended MCP assignment
follow special inactivity logic that may differ from the usual 90 day purge logic. Please see Appendix F: Assignment
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Pend Reason Codes for a complete list of pend reasons and the system inactivity logic for each MCP assignment
pend reason.
Managed Care Plan Assignment File
Description
This file is only accessible by MCPs and is comprised of plan enrolled members that do not have an open segment
(not closed or canceled) that are currently assigned or referred to the user’s MCP in either an active, pending, or
pended MCP assignment status.
This file includes a member’s demographic and contact information, last five unique providers that the member
saw according to recent Medicaid claim and encounters data, current HH/CMA assignment status if applicable, and
additional information that is optionally submitted into the system by the MCP through the MCP Final HH
Assignment File.
As of 11/22/2019 fields that have become obsolete will remain on the file but will no longer contain data. These
fields are indicated below with a “Null Value (blank)” value in the Format field,
Format
Managed Care Plan Assignment File
Field # Field
Start Pos Length
End Pos Req'd Source Format
1 Member ID 1 8 8 Y M'caid AA11111A, Alphanumeric
2 First Name 9 30 38 Y M'caid Alpha
3 Last Name 39 30 68 Y M'caid Alpha
4 DOB 69 8 76 Y M'caid MMDDYYYY, Numeric
5 County of Fiscal Responsibility Code
77 2 78 Y M'caid Numeric
6 County of Fiscal Responsibility Description
79 30 108 Y M'caid Alpha
7 Gender 109 1 109 Y M'caid Alpha (M/F)
8 HH Assignment Created Date 110 8 117 C Gen MMDDYYYY, Numeric
9 MCP MMIS Provider ID 118 8 125 Y M'caid Numeric
10 MCP Name 126 40 165 Y M’caid Alphanumeric
11 HH MMIS Provider ID 166 8 173 C MCP Numeric
12 HH NPI 174 10 183 C M'caid Numeric
13 HH Name 184 40 223 C M’caid Alphanumeric
14 Medicaid Eligibility End Date 224 8 231 C M'caid MMDDYYYY, Numeric
15 Medicare Indicator 232 1 232 Y M'caid Alpha (Y/N)
16 MDW Member Address Line 1 233 40 272 Y M'caid Alphanumeric
17 MDW Member Address Line 2 273 40 312 C M'caid Alphanumeric
18 MDW Member City 313 40 352 Y M'caid Alpha
19 MDW Member State 353 2 354 Y M'caid Alpha
20 MDW Member Zip Code 355 9 363 Y M'caid Numeric
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Managed Care Plan Assignment File
Field # Field
Start Pos Length
End Pos Req'd Source Format
21 MDW Member Phone 364 10 373 Y M'caid Numeric
22 Date of Patient Acuity 374 8 381 Blank N/A Null Value (blank)
23 Acuity Score 382 7 388 Blank N/A Null Value (blank)
24 Risk Score 389 6 394 Blank N/A Null Value (blank)
25 Outpatient Rank 395 6 400 Blank N/A Null Value (blank)
26 DOH Composite Score 401 6 406 Blank N/A Null Value (blank)
27 Service 1: Last Service Date 407 8 414 C M'caid MMDDYYYY, Numeric
28 Service 1: Last Service Provider Name
415 40 454 C M'caid Alpha
29 Service 1: Last Service Provider NPI
455 10 464 C M'caid Numeric
30 Service 1: Last Service Address Line 1
465 40 504 C M'caid Alphanumeric
31 Service 1: Last Service Address Line 2
505 40 544 C M'caid Alphanumeric
32 Service 1: Last Service City 545 40 584 C M'caid Alpha
33 Service 1: Last Service State 585 2 586 C M'caid Alpha
34 Service 1: Last Service Zip Code
587 9 595 C M'caid Numeric
35 Service 1: Last Service Phone Number
596 10 605 C M'caid Numeric
36 Service 2: Last Service Date 606 8 613 C M'caid MMDDYYYY, Numeric
37 Service 2: Last Service Provider Name
614 40 653 C M'caid Alpha
38 Service 2: Last Service Provider NPI
654 10 663 C M'caid Numeric
39 Service 2: Last Service Address Line 1
664 40 703 C M'caid Alphanumeric
40 Service 2: Last Service Address Line 2
704 40 743 C M'caid Alphanumeric
41 Service 2: Last Service City 744 40 783 C M'caid Alpha
42 Service 2: Last Service State 784 2 785 C M'caid Alpha
43 Service 2: Last Service Zip Code
786 9 794 C M'caid Numeric
44 Service 2: Last Service Phone Number
795 10 804 C M'caid Numeric
45 Service 3: Last Service Date 805 8 812 C M'caid MMDDYYYY, Numeric
46 Service 3: Last Service Provider Name
813 40 852 C M'caid Alpha
47 Service 3: Last Service Provider NPI
853 10 862 C M'caid Numeric
48 Service 3: Last Service Address Line 1
863 40 902 C M'caid Alphanumeric
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Managed Care Plan Assignment File
Field # Field
Start Pos Length
End Pos Req'd Source Format
49 Service 3: Last Service Address Line 2
903 40 942 C M'caid Alphanumeric
50 Service 3: Last Service City 943 40 982 C M'caid Alpha
51 Service 3: Last Service State 983 2 984 C M'caid Alpha
52 Service 3: Last Service Zip Code
985 9 993 C M'caid Numeric
53 Service 3: Last Service Phone Number
994 10 1003 C M'caid Numeric
54 Service 4: Last Service Date 1004 8 1011 C M'caid MMDDYYYY, Numeric
55 Service 4: Last Service Provider Name
1012 40 1051 C M'caid Alpha
56 Service 4: Last Service Provider NPI
1052 10 1061 C M'caid Numeric
57 Service 4: Last Service Address Line 1
1062 40 1101 C M'caid Alphanumeric
58 Service 4: Last Service Address Line 2
1102 40 1141 C M'caid Alphanumeric
59 Service 4: Last Service City 1142 40 1181 C M'caid Alpha
60 Service 4: Last Service State 1182 2 1183 C M'caid Alpha
61 Service 4: Last Service Zip Code
1184 9 1192 C M'caid Numeric
62 Service 4: Last Service Phone Number
1193 10 1202 C M'caid Numeric
63 Service 5: Last Service Date 1203 8 1210 C M'caid MMDDYYYY, Numeric
64 Service 5: Last Service Provider Name
1211 40 1250 C M'caid Alpha
65 Service 5: Last Service Provider NPI
1251 10 1260 C M'caid Numeric
66 Service 5: Last Service Address Line 1
1261 40 1300 C M'caid Alphanumeric
67 Service 5: Last Service Address Line 2
1301 40 1340 C M'caid Alphanumeric
68 Service 5: Last Service City 1341 40 1380 C M'caid Alpha
69 Service 5: Last Service State 1381 2 1382 C M'caid Alpha
70 Service 5: Last Service Zip Code
1383 9 1391 C M'caid Numeric
71 Service 5: Last Service Phone Number
1392 10 1401 C M'caid Numeric
72 MCP Assignment Created Date
1402 8 1409 Y Gen MMDDYYYY, Numeric
73 DOH Recommended HH MMIS Provider ID
1410 8 1417 Blank N/A Null Value (blank)
74 DOH Recommended HH Name
1418 40 1457 Blank N/A Null Value (blank)
75 HARP 1458 1 1458 Y M'caid Alpha (E/Y/N) If eligible set to Y, if
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Managed Care Plan Assignment File
Field # Field
Start Pos Length
End Pos Req'd Source Format
enrolled set to E, if neither set to N
76 MCP Assignment Status 1459 40 1498 Y Gen Alpha (Pending, Active, Pended)
77 HH Assignment Status 1499 40 1538 C MCP/HH Alpha (Pending, Active, Rejected, Ended)
78 Rejected Assignment Suggested HH Assignment
1539 8 1546 C HH Numeric
79 CMA MMIS Provider ID 1547 8 1554 C HH Numeric
80 CMA Name 1555 40 1594 C M’caid Alphanumeric
81 CMA Assignment Status 1595 40 1634 C HH/CMA Alpha (Pending, Active, Rejected, Ended)
82 Assignment Source 1635 20 1654 Blank N/A Null Value (blank)
83 Plan Provided Secondary Address – Street 1
1655 40 1694 C MCP Alphanumeric
84 Plan Provided Secondary Address – Street 2
1695 40 1734 C MCP Alphanumeric
85 Plan Provided Secondary Address – Apt/Suite
1735 20 1754 C MCP Alphanumeric
86 Plan Provided Secondary Address – City
1755 40 1794 C MCP Alpha
87 Plan Provided Secondary Address – State
1795 2 1796 C MCP Alpha
88 Plan Provided Secondary Address – Zip
1797 9 1805 C MCP Numeric
89 Plan Provided Member Phone Number
1806 10 1815 C MCP Numeric
90 Plan Provided Member Language
1816 30 1845 C MCP Alpha (see Appendix K: MCP Final HH Assignment File Accepted Values)
91 CMA Assignment End Reason Code
1846 2 1847 C
CMA Numeric (see Appendix G: Assignment End Reason Codes)
92 CMA Assignment End Reason Code Description
1848 40 1887 C Gen Alpha
93 CMA Assignment Record type 1888 10 1897 C Gen Alpha (Assignment, Referral, Transfer)
94 CMA Assignment Rejection Reason Code
1898 2 1899 C CMA Numeric (see Appendix E: Assignment Rejection Codes)
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Managed Care Plan Assignment File
Field # Field
Start Pos Length
End Pos Req'd Source Format
95 CMA Assignment Rejection Reason Code Description
1900 40 1939 C Gen Alpha
96 HH Assignment End Date 1940 8 1947 C Gen MMDDYYYY, Numeric
97 HH Assignment End Reason Code
1948 2 1949 C HH Numeric (see Appendix G: Assignment End Reason Codes)
98 HH Assignment End Reason Code Description
1950 40 1989 C Gen Alpha
99 HH Assignment Record type 1990 10 1999 C Gen Alpha (Assignment, Referral, Transfer)
100 HH Assignment Rejection Reason Code
2000 2 2001 C HH Numeric (see Appendix E: Assignment Rejection Codes)
101 HH Assignment Rejection Reason Code Description
2002 40 2041 C HH Alpha
102 HH Assignment Start Date 2042 8 2049 C HH MMDDYYYY, Numeric
103 MCP Assignment Record type 2050 10 2059 Y Gen Alpha (Assignment, Referral, Transfer)
104 End reason Comment 2060 300 2359 C HH/CMA Alphanumeric
105 Rejection reason Comment 2360 300 2659 C HH/CMA Alphanumeric
106 Pend Reason Code 2660 2 2661 C MCP Alphanumeric
107 Pend Reason Code Comment 2662 300 2961 C MCP Alphanumeric
108 CMA Assignment Created Date
2962 8 2969 C HH MMDDYYYY, Numeric
109 CMA Assignment Start Date 2970 8 2977 C CMA MMDDYYYY, Numeric
110 CMA Assignment End Date 2978 8 2985 C Gen MMDDYYYY, Numeric
111 Referral Suggested HH Assignment
2986 8 2993 C HH/CMA Numeric
112 MCP Assignment Start Date 2994 8 3001 C Gen MMDDYYYY, Numeric
113 Outreach/Enrollment Code 3002 1 3002 C Gen Alpha (O, E)
114 Segment HH Provider ID 3003 8 3010 C Gen Numeric
115 Segment HH Name 3011 40 3050 C Gen Alphanumeric
116 Segment End Date 3051 8 3058 C HH/CMA MMDDYYYY, Numeric
117 Segment End Date Reason Description
3059 40 3098 C HH/CMA Alpha
118 Segment End Date Reason Comment
3099 300 3398 C HH/CMA Alpha
119 Eligible for Outreach 3399 1 3399 C Gen Alpha (Y, N)
120 No of outreach mos within 12 mos
3400 2 3401 C Gen Numeric (01-12)
121 Child HCBS Flag 3402 1 3402 C User Alpha (O/N/H)
122 Suggested HH Name 3403 40 3442 C User Alphanumeric
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Managed Care Plan Assignment File
Field # Field
Start Pos Length
End Pos Req'd Source Format
123 Suggested HH MMIS Provider ID
3443 8 3450 C User Numeric
124 Suggested CMA Name 3451 40 3490 C User Alphanumeric
125 Suggested CMA MMIS Provider ID
3491 8 3498 C User Numeric
126 Engagement Optimization 3499 1 3499 C User Alpha
127 MCP Determined Eligibility 3500 23 3522 N User Numeric
Editing Logic
1. Health Home assignment (fields #8, #11-13)
a. These fields will be blank until the MCP assigns a member to a HH using the MCP Final HH
Assignment file. When the MCP submits a HH assignment, the HH Assignment Created will be
populated with the date that the system processed the MCP Final HH Assignment file uploaded
into the system by the MCP.
2. Last Five Unique Provider (fields #27-71)
a. These fields are populated with the last five unique providers with whom the member had a
service claim or an encounter. This excludes claims and encounters for durable medical
equipment, transportation, and pharmacy and includes physician, clinic, care management,
inpatient, and emergency department claims and encounters.
b. For members that only have two claims within the system that match the criteria listed in 3a,
only field numbers 27-44 will be populated. For members that are new to the Medicaid system,
do not have any claims or encounters in the system, or simply do not have any claims or
encounters that meet these criteria, these fields will be blank.
3. HH Assignment Fields (#77-78, #96-102 and #111)
a. The HH Assignment Status (field #77) contains a value if the MCP assigned a member to a HH. If
an MCP user sees a value of ‘Rejected’ in this field, then that user knows that the HH that the
MCP assigned the member to reject the member’s pending HH assignment. When the HH
rejected the pending HH assignment created by the MCP, the system ended the member’s
pending assignment with that HH and kept the member’s active MCP Assignment. The MCP
should use HH Assignment Rejection Reason Code (field #100) and HH Assignment Rejection
Reason Code Description (field #101) to further understand why the HH rejected the pending HH
assignment and determine a more suitable HH to assign the member to. If an MCP user sees a
value of ‘Ended’ in this field, then that user knows that the HH that the MCP assigned the
member to ended the member’s active HH assignment. When the HH ended the active HH
assignment created by the MCP, the system ended the member’s assignment with that HH and
kept the member’s active MCP Assignment. In this case, it is possible that the HH had a segment
with the member that ended and the HH decided to end the HH assignment when the segment
ended or the HH may have accepted the HH assignment, never created a segment, then decided
to end the HH assignment. The MCP should reassign a member with an ‘ended´ value in the HH
Assignment Status field to another HH, as appropriate. The MCP should look to HH Assignment
End Date (field #96), HH Assignment End Reason Code (field #97) and HH Assignment End
Reason Code Description (field #98) to further understand why the HH ended the active HH
assignment and determine, when appropriate, a more suitable HH to assign the member to. The
21 | P a g e
MCP should look at fields #117 and #118 to determine why a segment was ended (if any segment
exists). These fields are populated with the member’s most recent segment information and
therefore could be populated with information from prior to the most recent ended HH
assignment. By using fields #114 and #115 the MCP can determine when and by which HH the
segment was ended.
b. Fields #96-98 and #100-101 will only be populated if the ended or rejected HH assignment
(assignment must be reportable) overlaps at least one day with the period of time that the
member has an assignment with the downloading MCP.
c. HH Assignment Record Type (field #99) is populated for any HH assignment (in either pending,
active or ended status) that overlaps at least one day with the MCP assignment.
d. The Rejected Assignment Suggested HH Assignment (field #78) will only be populated if the HH
suggested another HH to which the member should be assigned when rejecting the pending HH
assignment or ending the active HH assignment. Members entered into the MAPP HHTS on or
after December 1, 2016 that were under 21 when they were entered into the system WILL NOT
contain a value in the Rejected Assignment Suggested HHAssignment (field #78) field.
e. HH Assignment End Date (field #96) and HH Assignment Start Date (field #102)
i. HH Assignment End Date (field #96) is populated with the date that the assignment was
ended by the HH and should always be populated if HH Assignment Status (field #77) is
populated with a value of ended or rejected.
ii. HH Assignment Start Date (field #102) is populated with the start date of the HH
assignment and should always be populated if HH Assignment Status (field #77) is
populated with a value of ended or active.
f. Referral Suggested HH Assignment (field #111) is populated with the MMIS ID of the HH that a
user suggests when the member has a Pending, Pended, or Active MCP assignment record with
record type of referral. For example, a user from CMA A makes a referral for Lindsey Lou. While
speaking with Lindsey, Lindsey asks to work with HH B, who is currently providing services for her
friend. CMA A, therefore populated the HH dropdown in the adult referral wizard with HH B,
which is now displayed for the MCP. The MCP should use this information when assigning
Lindsey downstream. Referrers are not required to complete this field and therefore it may be
blank.
Only the most recent HH information will be displayed in these fields. For instance, if an MCP first assigned a
member to HH A in March and then reassigned the member to HH B in June, the information listed in these fields
on or after June will apply to HH B, not HH A.
4. CMA Assignment Fields (# 79-81, # 91-95 and #108-110)
a. These fields will only be populated if the HH has assigned the member to a CMA. An MCP user
that sees a value of ‘rejected’ or ‘ended’ in CMA Assignment Status (field #81) knows that the
HH assigned the member to the CMA listed in fields #79 & #80 and that the CMA rejected/ended
the assignment. This tells the MCP that the HH that the MCP assigned the member to (fields
#11-13) should reassign the member to another CMA.
b. Fields #91-95 provide additional information as to why a CMA may have ended an active CMA
assignment or rejected a pending CMA assignment for any reportable CMA assignments that
overlap with the MCP assignment for at least one day. This information is helpful and should be
used to help inform the MCP when determining if a member needs to be reassigned to a
different HH.
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c. CMA Assignment Record Type (field #93) is populated for any CMA assignment (in either
pending, active or ended status) that overlaps at least one day with the MCP assignment.
d. Depending on the member’s status, fields #108-110 would also be populated as follows:
i. When field #81 is populated with Pending, CMA Assignment Created Date (field #108)
must be populated with the date that the reportable CMA assignment was created.
ii. When field #81 is populated with Active, CMA Assignment Created Date (field #108)
must be populated with the date that the reportable CMA assignment was created and
CMA Assignment Start Date (field #109) must be populated with the date that the CMA
assignment moved from Pending to Active.
iii. When field 81 is populated with Ended or Rejected, CMA Assignment Created Date
(field #108) must be populated with the date that the reportable CMA assignment was
created, and CMA Assignment Start Date (field #109) must be populated with the date
that the CMA assignment moved from Pending to Active, if applicable, and CMA
Assignment End Date (field #110) must be populated with the date that the pending
CMA assignment was rejected or the date that the Pending or Active CMA assignment
was ended.
5. End Reason Comment and Rejection Reason Comment (field #104-105)
a. End Reason Comment (field #104) should only be populated with a comment associated with the
ended CMA assignment if the member’s HH assignment that overlaps with the CMA assignment
is either Active or Null. If there is an ended HH assignment which overlaps with the MCP
assignment the HH End Reason Comment will be populated. If no end reason comments were
entered by the ending provider this field will be blank.
b. Reject Reason Comment (field #105) should only be populated with a comment associated with
the Rejected CMA assignment if the member’s HH assignment that overlaps with the CMA
assignment is either Active or Null. If there is a rejected HH assignment which overlaps with the
MCP assignment the HH Rejection Reason Comment will be populated. If no rejection reason
comments were entered by the rejecting provider this field will be blank.
6. Plan Supplied Fields (#83-90)
a. These fields will be blank unless the MCP submits information in these fields for the member
using the MCP Final HH Assignment file.
7. MCP Assignment Record Type (#103) and MCP Assignment Start Date (#112)
a. MCP Assignment Record Type (field #103) is the record type of the MCP assignment record. To
determine the correct assignment record to use, the system will compare Create Date(s), if any,
and Start Date(s), if any. The system will select the record type associated with the most recent
of the compared dates.
b. MCP Assignment Start Date (field #112) reflects the most recent of the member’s MCP
Assignment start dates and displays it.
8. Pend Reason (#106-107)
a. Pend Reason Code (field #106) will only include data if the MCP assignment record is Pended. If
the reason code is other,
a.b. Pend Reason Code Comment (field # 107) For any pend reason code, iwill be populated if a
comment is entered the comment entered by the pending provider will display in Pend Reason
Code Comment (field #107)when the assignment is pended, regardless of the Pend Reason Code.
This field is required when Pend Reason Code (field #106) is populated with pend reason code
‘Other’.
Formatted: Font: Bold
Formatted: Font: Bold
Formatted: Font: Not Bold
Formatted: Font: Italic
23 | P a g e
9. Medicaid Eligibility End Date (field #14)
a. Some Medicaid eligible members have indefinite Medicaid eligibility, meaning that their
Medicaid eligibility never expires. Within the Medicaid system, these members are listed with a
Medicaid eligibility end date of 12/31/9999. The MAPP HHTS does not use 12/31/9999 to
indicate that a member is indefinitely Medicaid eligible. This means that any member listed in
Medicaid with an end date of 12/31/9999 will be listed in the MAPP HHTS without a value in the
Medicaid Eligibility End Date (field #14).
10. Fields Relating to Member’s Most Recent Segment Information (fields #113-118)
a. The system will populate fields #113-118 with the most recent segment information (for any
segment that is in a non-cancelled or non-hiatus status) for any member regardless of if the
organization involved in the segment is associated with the downloading provider.
b. Outreach/Enrollment Code (field #113) specifies if the most recent segment the member had
was an outreach or an enrollment segment.
c. HH Provider ID (field #114) and HH Name (field #115) list the Health Home information
associated with the member’s most recent segment.
d. Segment End Date (field #116), Segment End Date Reason Description (field #117), and
Segment End Date Reason Comment (field #118) provide further information as to why the
most recent segment ended.
i. Providers are expected to use this information to determine if the member should be
assigned downstream. For example, should an MCP see a member on this file with an
Active MCP Assignment Status (field #76) but no HH Assignment Status (field #77) they
should review fields #114-118 to determine if it makes sense to assign the member to a
different Health Home or to pend the member.
1. If they see that the member had a Previous Enrollment Segment infield #113
with a Segment End Date Reason Description (field #117) of ‘Member no
longer requires HH services’ they would know that it is not appropriate to re-
assign the member at this time and instead they would pend the member.
2. If they see that the member had a Previous Enrollment Segment in field #113
with a Segment End Date Reason Description (field #117) of ‘Member moved
out of service county’ with a Segment End Date Reason Comment (field #118)
of “mbr now living in Monroe county” the MCP would know that they should
reassign the member to a Health Home that serves Monroe County.
11. Fields Related to Outreach (fields #119-120)
a. Eligible for Outreach (field #119) will display a N if a member has 2 or more months of outreach
in a status other than Cancelled or Hiatus within the last 12 months. If the member has 1 or less
months of outreach in a status other than Cancelled or Hiatus in the last 12 months, the field will
display a Y. Effective 7/1/20, outreach is no longer a Medicaid covered service.
b. No of outreach mos within 12 mos (field #120) displays a count of the number of months of
outreach in a status other than Cancelled or Hiatus for the member within the last 12 months.
i. Providers should use the data in these 2 fields as well as any new information that they
have regarding a member to determine if it is appropriate to re-assign a member
downstream.
ii. The 12-month periods are based on the date the file is downloaded. The month that the
user is downloading the file is included in the 12-month count. For example, if a
provider downloads the file on 12/10/2017 the system will calculate the number of
months of outreach the member had between 1/1/2017 and 12/31/2017.
24 | P a g e
12. Use the member’s date of birth to determine if an assignment is for a child or an adult.
13. Child HCBS Flag (field #121) For children referred into the program on or after 1/10/19 this field
will be populated based on the referral rationale selected during the referral process in the
Children’s Referral Portal (CRP). Children referred into the program prior to 1/10/19 will have a
record with a blank value in this field. Adults will have a record with a blank value in this field both
prior to and after 1/10/19.
i. The system will populate the field with “Y” if “HCBS Only” was selected for the member on
the Referral Rationale Screen in the CRP.
ii. The system will populate the field with “H” if “Chronic Conditions and HCBS” was selected
for the member on the Referral Rational Screen in the CRP.
iii. The system will populate the field with “N” if “Chronic Conditions Only” was selected for the
member on the Referral Rationale Screen on the Referral Rational Screen in the CRP
19. Fields Relating to Suggested Providers Selected during a Child Referral (fields #122-125)
a. MAPP will populate these fields based on a referrer’s responses when referring a child via the CRP.
b. If the member was not referred, was referred using the Adult Referral Wizard/File, was a child
referred prior to 1/10/19, was entered directly into a segment, or the referrer did not select a
suggested provider, these fields will be blank.
c. If the member has had multiple referrals where suggested providers were selected, the system will
display the most recently suggested provider information.
20. Engagement Optimization (field #126-127)
a. Engagement Optimization (#126) is populated with A-C (now excluding Y) or blank if indicated by the
MCP upon file upload. These values represent different types of MCP initiated engagement plans.
Value descriptions are listed in Appendix K: MCP Final HH Assignment File Accepted Values
b. MCP Determined Eligibility (#127) is populated with up to 8 two-digit eligibility codes that are
deliminated with a space. These values and their definition can be found in Appendix K: MCP Final HH
Assignment File Accepted Values.
c. Both of these fields are associated with the MCP that uploaded the file and its downstream providers.
If a member switches from MCP to FFS or switches MCPs these values will no longer display.
Child Referral Download File
Description
This file contains information collected about a member that was entered into the MAPP HHTS through the
Children’s HH Referral Portal.
MCP users can download the Child Referral Download file to view members under 21 years of age that have a
pending, pended, or active (but no segments in a non-cancelled or non-closed status) assignment record associated
with their organization. HH and CMA users can download the Child Referral Download file to view members under
21 years of age that have a reportable pending or active assignment record (but no segments in a non-cancelled or
non-closed status) associated with their organization.
25 | P a g e
Format
Child Referral Download File
Field # Field
Start Pos Length
End Pos Req’d Format
1 Member ID 1 8 8 Y AA11111A, Alphanumeric
2 First Name 9 30 38 Y Alpha
3 Last Name 39 30 68 Y Alpha
4 DOB 69 8 76 Y MMDDYYYY, Numeric
5 Referrer First Name 77 30 106 Y Alpha
6 Referrer Last Name 107 30 136 Y Alpha
7 Referrer Organization name 137 30 166 Y Alpha
8 Referrer Organization ID 167 8 174 Y Numeric
9 Consenting Individual to Refer 175 95 269 Y Alpha
10 Consenter First Name 270 30 299 Y Alpha
11 Consenter Last Name 300 30 329 Y Alpha
12 Consenter Area Code 330 3 332 N Numeric
13 Consenter Phone Number 333 7 339 N Numeric
14 Consenter Preferred Communication 340 5 344 N Alpha
15 Consenter Pref. Time of Day 345 9 353 N Alpha
16 Consenter Email Address 354 40 393 N Alpha
17 Additional Info on Chronic Conditions 394 300 693 N Alphanumeric
18 Comments Related to Referral 694 300 993 N Alphanumeric
19 Originating Referral Source Contact Name 994 60 1053 N Alpha
20 Originating Referral Source Organization 1054 30 1083 C Alphanumeric
21 Originating Referral Source Street 1 1084 30 1113 C Alphanumeric
22 Originating Referral Source Street 2 1114 30 1143 N Alphanumeric
23 Originating Referral Source City 1144 30 1173 C Alpha
24 Originating Referral Source State 1174 2 1175 C Alpha
25 Originating Referral Source Zip Code 1176 9 1184 C Numeric
26 Originating Referral Source Area Code 1185 3 1187 C Numeric
27 Originating Referral Source Phone Number 1188 7 1194 C Numeric
28 Originating Referral Source Extension 1195 5 1199 C Numeric
29 Originating Referral Source Phone Type 1200 4 1203 C Alpha (Home, Cell, Work)
30 Comments 1204 300 1503 N Alphanumeric
31 HCBS Referral Indicator 1504 30 1533 C Alpha (HCBS/None)
32 Chronic Conditions 1534 100 1633
C
Alpha (Two or more chronic conditions, SED, Complex Trauma, HIV/AIDs, None)
26 | P a g e
Child Referral Download File
Field # Field
Start Pos Length
End Pos Req’d Format
33 Suggested HH Name 1634 40 1673 C Alpha
34 Suggested HH MMIS ID 1674 8 1681 C Numeric
35 Suggested CMA Name 1682 40 1721 C Alpha
36 Suggested CMA MMIS ID 1722 8 1729 C Numeric
Editing Logic
Fields #1-36 are populated for any member under 21 years of age submitted to the system through the Children’s
Referral Portal (CRP) with pended, ending, or active assignments and no segments as of the date the file is
downloaded. If there is more than one referral per member, the most recent referral data is populated.
1. Data fields (#1-4) include the member’s Member ID (field #1), First Name (field #2), Last Name (field #3),
and DOB (field #4) information from the Medicaid Data Warehouse.
2. Data fields (#5-6) include the Referrer First Name (field #5) and Referrer Last Name (field #6) of the user
(referrer) that submitted the most recent referral via the CRP.
3. Referrer Organization Name (field #7), is populated with the Managed Care Plan Name, Health Home
Program Name, Care Management Agency Program Name, LGU Organization Name, LDSS Organization
Name, or SPOA Organization Name, of the organization that submitted the most recent referral via the
CRP. If DOH submitted the referral, the organization that DOH submitted on behalf of populates in this
field.
4. Referrer Organization ID (field #8), is populated with the MMIS ID or HCS ID of the organization that
submitted the most recent referral via the CRP. If DOH submitted the referral, the MMIS ID or HCS ID of
the organization that DOH submitted on behalf of populates in this field.
5. Consenting Individual to Refer (field #9), includes the consenter's relationship with the member selected
on the Consenter screen from the most recent referral via the CRP.
6. Data fields (#10-13) includes the Consenter First Name (field #10), Last Name (field #11), Consenter Area
Code (field #12), and Consenter Phone Number (field #13). This information is retrieved from the most
recent referral for the member that was submitted via the CRP.
7. Data fields (#14-16) include the consenter’s contact details. The Consenter Preferred Communication
(field #14), Consenter Preferred Time of Day for Contact (field #15), and Consenter Email Address (field
#16). Information is retrieved from the most recent referral for the member that was submitted via the
CRP.
8. Data fields (#17-18) include Additional Info on Chronic Conditions (field #17) which is any free text
response entered under the chronic conditions page of the Children’s Referral Portal and Comments
Related to Referral (field #18) which is any free text response entered under the Consenter Contact
information of the Children’s Referral Portal.
9. Data fields (#19-30) are populated with information only if the provider entering a children’s referral has
indicated that someone outside of their organization provided them with the referral information outside
of MAPP HHTS. The system then populates these fields with any information the MAPP HHTS user entered
related to the provider who originally identified the member as Health Home eligible and made the
referral.
10. Fields Pertaining to the HH Qualifying Conditions of the Member (field #31-32)
27 | P a g e
a. HCBS Referral Indicator(field #31) indicates if the referrer felt that the member qualified for HH
services based on being part of the HCBS identified population.
b. Chronic Conditions (field #32) indicates what Chronic Conditions the member has that qualifies
the member to be referred into the HH program.
c. Should the member not have either HCBS or Chronic Conditions the respective field will indicate
this by populating the response ‘None’.
11. Fields Relating to Suggested Providers (fields #33-36)
a. The system will populate these fields based on a referrer’s responses when referring a child via
the CRP.
b. If the child was referred prior to 1/10/19 or the referrer did not select a suggested provider,
these fields will be blank.
Managed Care Plan Final Health Home Assignment File
Description
This file is only uploaded by MCP users and is used to assign a current plan member to a HH, to pend MCP
Assignments, and to upload plan supplied member contact, language, and optimization information into the
system. The contact, language, and optimization fields in this file upload are not required. If an MCP submits this
information into the system using the MCP Final HH Assignment file, the submitted values will be included in the
MCP Assignment and the HH Assignment download files and may be stored as evidence under the Personal
Information tab on the member’s Home Page.
Format
Managed Care Plan Final Health Home Assignment File
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Member ID 1 8 8 Y AA11111A, Alphanumeric
2 HH MMIS Provider ID 9 8 16 C Numeric
3 Pend Reason Code 17 2 18 C Alphanumeric
4 Plan Provided Secondary Address – Street 1
19 40 58 C Alphanumeric
5 Plan Provided Secondary Address – Street 2
59 40 98 C Alphanumeric
6 Plan Provided Secondary Address – Apt/Suite
99 20 118 C Alphanumeric
7 Plan Provided Secondary Address – City
119 40 158 C Alpha
8 Plan Provided Secondary Address – State
159 2 160 C Alpha
9 Plan Provided Secondary Address – Zip
161 9 169 C Numeric
10 Plan Provided Member Phone Number
170 10 179 C Numeric
11 Plan Provided Member Language 180 30 209 C Alpha
12 Engagement Optimization 210 1 210 N Alpha
13 MCP Determined Eligibility 211 23 233 N Numeric
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Editing Logic
Listed below are the systems actions that can be performed within the system using the MCP Final HH Assignment
file in addition to edits applied when an MCP Final HH Assignment file is uploaded to the system.
1. Assign a member with an active, pending, or pended MCP assignment, NO corresponding segments that are
not closed or cancelled.
a. Submit a record containing the member’s CIN in Member ID (field #1) and the MMIS Provider ID
of the HH that the MCP is assigning the member to in the HH MMIS Provider ID (field #2) field.
2. Reassign a member with an active or pending HH assignment, NO corresponding segments that are not closed
or cancelled, AND NO* CMA assignments to a new HH.
a. To switch a member’s HH assignment from HH A to HH B, include the member on the MCP Final
HH Assignment file with the MMIS Provider ID of the new HH (HH B) that the MCP would like to
reassign the member to in HH MMIS Provider ID (field #2). This will end the member’s original
HH assignment (HH A in this example) and create a pending assignment with the newly assigned
HH (HH B in this example).
b. The HH assignment (HH A) will be ended once the MCP submits the MCP Final HH Assignment file
reassigning the member to a new HH (HH B).
c. This will not change the member’s active MCP assignment status.
*If the member has a pending or active CMA Assignment, then the system will end date the pending or active CMA
assignment.
3. Assign a member that does not have an active assignment in the system and is over 21 (member does not
have an assignment with the MCP or any other provider in the system) and does not have a segment in the
system.
a. For example, an MCP user identifies a new plan member that is Health Home eligible and
appropriate for the program.
b. To enter the member into the system and create an active MCP assignment (no HH assignment
yet), the MCP user would:
i. Submit a record containing the member’s CIN and do not include information in HH
MMIS Provider ID (field #2) or Pend Reason Code (field #3).
c. To enter the member into the system to create an active MCP assignment and a pending HH
assignment, the MCP user would:
i. Submit a record containing the member’s CIN and the MMIS Provider ID of the HH that
the MCP is assigning the member to in HH MMIS Provider ID (field #2) field AND do not
populate Pend Reason Code (field #3).
4. Pend the assignment for a member with an active, pending or a pended MCP assignment
a. To pend a member’s MCP assignment, HH MMIS Provider ID (field #2) must be blank and Pend
Reason Code (field #3) must be populated with one of the valid pend reason codes listed in
Appendix F: Assignment Pend Reason Codes. Please note that the assignment pend reason codes
are different than the segment pend reason codes.
5. Uploading MCP supplied address information into the system.
a. The Plan Supplied Address (fields #4-9) can be populated anytime the MCP Final HH Assignment
file is uploaded to the system and are always optional. However, when these fields are
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populated, the following edits are used to ensure that only valid address information is
submitted into the system.
i. Plan Provided Secondary Address – Street 1 (field #4) must contain at least 3
characters.
ii. Plan Provided Secondary Address – Zip (field #9) must contain a valid zip code format.
This 9-character field must contain either the five-digit zip code format (xxxxx) or the
five-digit zip code plus four format (xxxxxxxxx).
iii. Plan Provided Secondary Address – City (field #7) must contain letters only.
iv. Values submitted to the system in field # 4-9 will be stored as Plan Supplied address
evidence in the person information tab of a member’s home page.
v. When submitting address information, all of the main address fields (#4, #7-9) must be
populated with a valid value for the record to be accepted. For instance, if the Plan
Provided Secondary Address – State (field #8) contains a value of ‘NY’, then the record
will only be accepted if fields #4, #7, and #9 are also populated with valid values.
6. Uploading MCP supplied phone number information into the system.
a. Plan Provided Member Phone Number (field #10) is not required. However, when it is
populated, it must contain a 10-digit number. If a record is submitted that doesn’t meet these
criteria the record will not be accepted.
7. Uploading MCP supplied language information into the system.
a. Plan Provided Member Language (field #11) is not required. However, when it is populated, it
must contain one of the languages listed in Appendix K: MCP Final HH Assignment File Accepted
Values. If a record is submitted with a value in Plan Provided Member Language (field #11) that
is not listed in Appendix K, the record will be accepted, but the unaccepted value listed in Plan
Provided Member Language (field #11) will not be recorded within the system.
8. Uploading MCP Optimization and Eligibility information
a. Member CIN (field #1) is required if a user submits an accepted value in either the Engagement
Optimization (field #12) or MCP Determined Eligibility (#13) field. Please see Appendix K: MCP
Final HH Assignment File Accepted Values for a list of accepted values.
b. An MCP can submit acceptable values in one or both of these fields and also submit other
information in any other fields (#2-11).
c. Providers can submit a ‘D’ record to remove a value previously submitted in the Engagement
Optimization field. When submitted a ‘D’ record, all additional fields other than Member CIN
(#1) must be blank. This will result in a blank value in the Engagement Optimization field in the
Managed Care Plan Assignment download file and the Health Home Assignment download file.
d. Providers can submit up to 8 of the 2-digit MCP Determined Eligibility codes (with a space
deliminter) listed in Appendix K in the MCP Determined Eligibility field. If a value has already
been submitted to this field, it can be rewritten by submitting another record with values in this
field.
9. Member must be enrolled in the user’s MCP as of the file submission date, per the member’s Medicaid
information in the system, for the system to accept the record. The Medicaid information in the system can be
up to a week behind the official Medicaid system, so if a member is newly enrolled in the user’s MCP, the user
may have to wait up to a week before the system recognizes that the member is enrolled in the user’s MCP
and accepts the record.
10. The MMIS Provider ID submitted in HH MMIS Provider ID (field #2) must be a valid HH MMIS Provider ID that
has an active relationship with the submitting user’s MCP as of the file submission date.
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11. Members submitted in this file cannot have an outreach or enrollment segment in the system in any status
except Closed or Canceled.
12. A record cannot contain a value in both HH MMIS Provider ID (field #2) and Pend Reason Code (field #3).
13. A record will be rejected for an action that has already taken place. For example, if the member has already
been assigned to HH A and the MCP user uploads the file for that member with HH A listed in the HH MMIS
Provider ID (field #2), then the record will be rejected.
14. As of the file submission date, a member submitted on this file cannot have a coverage code or a recipient R/E
code that is incompatible with the Health Home program (see Appendix L: Reference and Contacts for links to
recipient R/E codes and coverage codes that are not compatible with the Health Home program).
Error Report: Managed Care Plan Final Health Home Assignment File
Description
This file is created upon validating or processing an MCP Final HH Assignment file containing at least one error. An
Error Report: MCP Final HH Assignment file will not be created for an MCP Final HH Assignment file that does not
contain rejected records. The Error Report: MCP Final HH Assignment file will contain one record for each record
in the MCP Final HH Assignment file that contains an error.
Format
Error Report: Managed Care Plan Final Health Home Assignment File
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Line Number 1 6 6 Y Numeric
2 Member ID 7 8 14 Y AA11111A, Alphanumeric
3 HH MMIS Provider ID 15 8 22 C Numeric
4 Error Reason 23 30 52 Y Alphanumeric
5 Pend Reason Code 53 2 54 C Alphanumeric
Editing Logic
The Error Reason (field #4) will be populated with a description of why the record was rejected. This field will only
contain one error description. If a record hits more than one error, only the first error will be displayed in the
Error Reason field. This error file contains both file format errors and logic errors. For more information on errors,
please review Appendix B: File Error Reason Codes.
Health Home Assignment File
Description
This file is accessible by both HHs and CMAs and is comprised of members that are currently assigned/referred to
the user’s organization in either an active or pending assignment status with the downloading provider, but do not
have an outreach or enrollment segment in any status, except closed or cancelled. It also contains information on
members that have a pending or rejected transfer with the HH/CMA downloading the file.
This file includes a member’s demographic and contact information, current HH/CMA assignment status if
applicable, the member’s last five unique providers according to recent Medicaid claim and encounters, and
additional information that is optionally submitted into the system by the MCP through the MCP Final HH
Assignment File.
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As of 11/22/2019 fields that have become obsolete will remain on the file but will no longer contain data. These
fields are indicated below with a ‘Null Value (blank)” value in the Format field.
Format
Health Home Assignment File
Field # Field Start Pos Length End Pos Req'd Source Format
1 Member ID 1 8 8 Y M'caid AA11111A, Alphanumeric
2 First Name 9 30 38 Y M'caid Alpha
3 Last Name 39 30 68 Y M'caid Alpha
4 DOB 69 8 76 Y M'caid MMDDYYYY, Numeric
5 County of Fiscal Responsibility Code
77 2 78 Y M'caid Numeric
6 County of Fiscal Responsibility Description
79 30 108 Y M'caid Alpha
7 Gender 109 1 109 Y M'caid Alpha (M/F)
8 HH Assignment Created Date 110 8 117 C Gen MMDDYYYY, Numeric
9 MCP MMIS Provider ID 118 8 125 C M'caid Numeric
10 MCP Name 126 40 165 C M'caid Alphanumeric
11 HH MMIS Provider ID 166 8 173 C Gen Numeric
12 HH NPI 174 10 183 C M'caid Numeric
13 HH Name 184 40 223 C M'caid Alphanumeric
14 Medicaid Eligibility End Date 224 8 231 C M'caid MMDDYYYY, Numeric
15 Medicare Indicator 232 1 232 Y M'caid Alpha (Y/N)
16 MDW Member Address Line 1 233 40 272 Y M'caid Alphanumeric
17 MDW Member Address Line 2 273 40 312 C M'caid Alphanumeric
18 MDW Member City 313 40 352 Y M'caid Alpha
19 MDW Member State 353 2 354 Y M'caid Alpha
20 MDW Member Zip Code 355 9 363 Y M'caid Numeric
21 MDW Member Phone 364 10 373 Y M'caid Numeric
22 Date of Patient Acuity 374 8 381
Blank Null Value (blank)
23 Acuity Score 382 7 388
Blank Null Value (blank)
24 Risk Score 389 6 394
Blank Null Value (blank)
25 Outpatient Score 395 6 400
Blank Null Value (blank)
26 DOH Composite Score 401 6 406
Blank Null Value (blank)
27 Service 1: Last Service Date 407 8 414 C M'caid MMDDYYYY, Numeric
28 Service 1: Last Service Provider Name
415 40 454 C M'caid Alpha
29 Service 1: Last Service Provider NPI
455 10 464 C M'caid Numeric
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Health Home Assignment File
Field # Field Start Pos Length End Pos Req'd Source Format
30 Service 1: Last Service Address Line 1
465 40 504 C M'caid Alphanumeric
31 Service 1: Last Service Address Line 2
505 40 544 C M'caid Alphanumeric
32 Service 1: Last Service City 545 40 584 C M'caid Alpha
33 Service 1: Last Service State 585 2 586 C M'caid Alpha
34 Service 1: Last Service Zip Code 587 9 595 C M'caid Numeric
35 Service 1: Last Service Phone Number
596 10 605 C M'caid Numeric
36 Service 2: Last Service Date 606 8 613 C M'caid MMDDYYYY, Numeric
37 Service 2: Last Service Provider Name
614 40 653 C M'caid Alpha
38 Service 2: Last Service Provider NPI
654 10 663 C M'caid Numeric
39 Service 2: Last Service Address Line 1
664 40 703 C M'caid Alphanumeric
40 Service 2: Last Service Address Line 2
704 40 743 C M'caid Alphanumeric
41 Service 2: Last Service City 744 40 783 C M'caid Alpha
42 Service 2: Last Service State 784 2 785 C M'caid Alpha
43 Service 2: Last Service Zip Code 786 9 794 C M'caid Numeric
44 Service 2: Last Service Phone Number
795 10 804 C M'caid Numeric
45 Service 3: Last Service Date 805 8 812 C M'caid MMDDYYYY, Numeric
46 Service 3: Last Service Provider Name
813 40 852 C M'caid Alpha
47 Service 3: Last Service Provider NPI
853 10 862 C M'caid Numeric
48 Service 3: Last Service Address Line 1
863 40 902 C M'caid Alphanumeric
49 Service 3: Last Service Address Line 2
903 40 942 C M'caid Alphanumeric
50 Service 3: Last Service City 943 40 982 C M'caid Alpha
51 Service 3: Last Service State 983 2 984 C M'caid Alpha
52 Service 3: Last Service Zip Code 985 9 993 C M'caid Numeric
53 Service 3: Last Service Phone Number
994 10 1003 C M'caid Numeric
54 Service 4: Last Service Date 1004 8 1011 C M'caid MMDDYYYY, Numeric
55 Service 4: Last Service Provider Name
1012 40 1051 C M'caid Alpha
56 Service 4: Last Service Provider NPI
1052 10 1061 C M'caid Numeric
57 Service 4: Last Service Address Line 1
1062 40 1101 C M'caid Alphanumeric
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Health Home Assignment File
Field # Field Start Pos Length End Pos Req'd Source Format
58 Service 4: Last Service Address Line 2
1102 40 1141 C M'caid Alphanumeric
59 Service 4: Last Service City 1142 40 1181 C M'caid Alpha
60 Service 4: Last Service State 1182 2 1183 C M'caid Alpha
61 Service 4: Last Service Zip Code 1184 9 1192 C M'caid Numeric
62 Service 4: Last Service Phone Number
1193 10 1202 C M'caid Numeric
63 Service 5: Last Service Date 1203 8 1210 C M'caid MMDDYYYY, Numeric
64 Service 5: Last Service Provider Name
1211 40 1250 C M'caid Alpha
65 Service 5: Last Service Provider NPI
1251 10 1260 C M'caid Numeric
66 Service 5: Last Service Address Line 1
1261 40 1300 C M'caid Alphanumeric
67 Service 5: Last Service Address Line 2
1301 40 1340 C M'caid Alphanumeric
68 Service 5: Last Service City 1341 40 1380 C M'caid Alpha
69 Service 5: Last Service State 1381 2 1382 C M'caid Alpha
70 Service 5: Last Service Zip Code 1383 9 1391 C M'caid Numeric
71 Service 5: Last Service Phone Number
1392 10 1401 C M'caid Numeric
72 HARP Flag 1402 1 1402 Y DOH Alpha (Y/N/E) If HARP eligible, set to Y; if enrolled set to E; if neither set to N
73 MCP Assignment Status 1403 40 1442 C MCP Alpha (Pending, Active, Pended by MCP)
74 HH Assignment Status 1443 40 1482 C MCP/HH Alpha (Pending, Active, Rejected, Ended)
75 Suggested Alternative CMA Assignment
1483 8 1490 C CMA Numeric
76 CMA MMIS Provider ID 1491 8 1498 C HH Numeric
77 CMA Name 1499 40 1538 C M'caid Alphanumeric
78 CMA Assignment Status 1539 40 1578 C HH/CMA Alpha (Pending, Active, Rejected, Ended)
79 Assignment Source 1579 20 1598
Blank Null Value (blank)
80 Plan Provided Secondary Address – Street 1
1599 40 1638 C MCP Alphanumeric
81 Plan Provided Secondary Address – Street 2
1639 40 1678 C MCP Alphanumeric
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Health Home Assignment File
Field # Field Start Pos Length End Pos Req'd Source Format
82 Plan Provided Secondary Address – Apt/Suite
1679 20 1698 C MCP Alphanumeric
83 Plan Provided Secondary Address – City
1699 40 1738 C MCP Alpha
84 Plan Provided Secondary Address – State
1739 2 1740 C MCP Alpha
85 Plan Provided Secondary Address – Zip
1741 9 1749 C MCP Numeric
86 Plan Provided Member Phone Number
1750 10 1759 C MCP Numeric
87 Plan Provided Member Language
1760 30 1789 C MCP Alpha
88 CMA Assignment End Reason
1790 2 1791 C CMA Numeric
89 CMA Assignment End Reason Code Description
1792 40 1831 C Gen
Alpha
90 CMA Assignment Record type
1832 10 1841 C Gen Alpha (Assignment, Referral, Transfer)
91 CMA Assignment Rejection Reason Code
1842 2 1843 C CMA
Numeric
92 CMA Assignment Rejection Reason Code Description
1844 40 1883 C Gen Alpha
93 HH Assignment Record type 1884 10 1893 C Gen Alpha (Assignment, Referral, Transfer)
94 HH Assignment Start Date 1894 8 1901 C Gen MMDDYYYY, Numeric
95 MCP Assignment Record type
1902 10 1911 C Gen Alpha (Assignment, Referral, Transfer)
96 MCP Type 1912 40 1951 C Gen Alpha
97 End reason Comment 1952 300 2251 C CMA Alphanumeric
98 Rejection reason Comment 2252 300 2551 C CMA Alphanumeric
99 CMA Assignment Created Date
2552 8 2559 C CMA MMDDYYYY, Numeric
100 CMA Assignment Start Date 2560 8 2567 C CMA MMDDYYYY, Numeric
101 CMA Assignment End Date 2568 8 2575 C CMA MMDDYYYY, Numeric
102 Rejected Assignment Suggested Alt Assignment
2576 8 2583 C HH/CMA Numeric
103 MCP Assignment Created Date
2584 8 2591 R Gen MMDDYYYY, Numeric
104 MCP Assignment Start Date 2592 8 2599 R Gen MMDDYYYY, Numeric
105 Outreach/Enrollment Code 2600 1 2600 C Gen Alpha (O, E)
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Health Home Assignment File
Field # Field Start Pos Length End Pos Req'd Source Format
106 Segment HH MMIS Provider ID
2601 8 2608 C Gen Numeric
107 Segment HH Name 2609 40 2648 C Gen Alphanumeric
108 Segment End Date 2649 8 2656 C HH/CMA MMDDYYYY, Numeric
109 Segment End Date Reason Description
2657 40 2696 C HH/CMA Alpha
110 Segment End Date Reason Comment
2697 300 2996 C HH/CMA Alpha
111 Eligible for Outreach 2997 1 2997 C Gen Alpha (Y, N)
112 No of outreach mos within 12 mos
2998 2 2999 C Gen Numeric (01-12)
113 Child HCBS Flag 3000 1 3000 C Referrer Alpha (O/N/H)
114 Suggested HH Name 3001 40 3040 C Referrer Alphanumeric
115 Suggested HH MMIS Provider ID
3041 8 3048 C Referrer Numeric
116 Suggested CMA Name 3049 40 3088 C Referrer Alphanumeric
117 Suggested CMA MMIS Provider ID
3089 8 3096 C Referrer Numeric
118 Engagement Optimization 3097 1 3097 C MCP Alpha
119 Transfer Initiator MMIS ID 3098 8 3105 C HH/CMA Numeric
120 Transfer Initiator Organization Name
3106 40 3145 C HH/CMA Alpha
121 Transfer Receiver MMIS Provider ID
3146 8 3153 C HH/CMA Numeric
122 Transfer Receiver Organization Name
3154 40 3193 C HH/CMA Alpha
123 Transfer Create Date 3194 8 3201 C HH/CMA Date
124 Transfer Effective Date 3202 8 3209 C HH/CMA Date
125 Transfer Reason 3210 75 3284 C HH/CMA Alpha
126 Transfer Comment 3285 300 3584 C HH/CMA Alphanumeric
127 MCP Determined Eligibility 3585 23 3607 C MCP Numeric
Editing Logic
1. When an HH user accesses this file, it contains both managed care enrolled and fee for service members
that have an active or pending assignment with the downloading provider. Members enrolled in in a
managed care plan will have an active MCP assignment status. For fee for service members, MCP MMIS
Provider ID (field #9), MCP Name (field #10), and the MCP Assignment Status (field #73) will be blank.
a. For members that have been assigned to a CMA, CMA Assignment Status (field #78) will contain
one of four values: pending, meaning that the HH assigned the member to a CMA, but that the
CMA has not yet accepted or rejected the member’s assignment; active, meaning that the CMA
accepted the member’s assignment made to the CMA by the HH; rejected meaning that the HH
assigned the member to a CMA, but that the CMA rejected the pending CMA assignment; or
ended meaning that the HH assigned the member to a CMA, the CMA accepted that assignment,
36 | P a g e
and then the CMA ended the active CMA assignment. If the member has not yet been assigned
to a CMA, then CMA Assignment Status (field #78) will be blank.
b. When CMA assignment Status (field #78) is populated the HH user can use the CMA fields (#88-
92) to learn more about the CMA assignment. See number 8 for more information on CMA fields.
2. When a CMA user accesses this file, it contains both managed care enrolled and fee for service members
that have an active or pending CMA assignment with the downloading provider. It is possible for members
enrolled in managed care working with a voluntary foster care agency (VFCA) CMA to have an active MCP
assignment, no HH assignment, and then a pending or active CMA assignment status. Fee for service
members will have an active HH assignment and MCP MMIS Provider ID (field #9), MCP Name (field #10),
and the Managed Care Plan Assignment Status (field #73) will be blank. In the case of a Voluntary Foster
Care Agency (VFCA) it is possible to see a blank MCP assignment and a blank HH. In the CMA Assignment
Status (field #78), members will either have a value of pending, meaning that the CMA has to either
accept or reject the assignment, or a value of active, meaning that the CMA accepted the assignment
made to the CMA.
3. Medicaid Eligibility End Date: Some Medicaid eligible members have indefinite Medicaid eligibility,
meaning that their Medicaid eligibility never expires. Within the Medicaid system, these members are
listed with a Medicaid eligibility end date of 12/31/9999. MAPP HHTS will not use 12/31/9999 to indicate
that a member is indefinitely Medicaid eligible. This means that any member listed in Medicaid with an
end date of 12/31/9999 will be listed in the MAPP HHTS without a value in Medicaid Eligibility End Date
(field #14).
4. Fields #80-87, 118, and 127 will only be populated if the member’s plan submitted information on the
MCP Final HH Assignment file.
a. A list of accepted values and their definition for Engagement Optimization (field #118) and MCP
Determined Eligibility (field #127) can be found in Appendix K: MCP Final HH Assignment File
Accepted Values and are meant to help the HH/CMA provider know that the MCP has already
reviewed the members case and/or discussed the HH program with them.
5. Last Five Unique Provider (fields #27-71)
a. These fields are populated with the last five unique providers with whom the member had a
service claim or an encounter. This excludes claims and encounters for durable medical
equipment, transportation, and pharmacy and includes physician, clinic, care management,
inpatient, and emergency department claims and encounters.
b. For members that only have two claims within the system that match the criteria listed in 7a,
only field numbers #27-44 will be populated. For members that are new to the Medicaid system,
do not have any claims or encounters in the system, or simply do not have any claims or
encounters that meet these criteria, these fields will be blank.
6. CMA Assignment (fields #76-78, #88-92 and #99-101)
a. These fields will only be populated when a HH downloads the file if the HH has assigned the
member to a CMA. A HH user that sees a value of ‘rejected’ or ‘ended’ in CMA Assignment
Status (field #78) knows that the HH assigned the member to the CMA and that the CMA
rejected/ended the assignment. This tells the HH that they assigned the member to a CMA
(fields #11-13) and now must reassign the member to another CMA. The HH should review for
ended CMA assignments (fields #88-89) and for rejected CMA Assignments (fields #91-92) to aid
in the reassignment process.
i. These fields are only populated when the user is downloading on behalf of a HH and a
reportable assignment record is Ended (#88-89) or Rejected (#91-92) by the CMA and it
overlaps for at least one day with the HH assignment record period.
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ii. These fields should never be populated when a CMA user is downloading the file.
b. CMA Assignment Record Type (field #90) and CMA Assignment Status (field #78) should always
be populated when the file is downloaded by a HH user and when a reportable CMA Assignment
overlaps for at least one day with the HH assignment record period. CMA Assignment Record
Type (field #90) and CMA Assignment Status (field #78) should always be populated when the
file is downloaded by a CMA user.
c. Depending on the member’s status, fields #99 -101 must also be populated as follows:
i. When field #78 is populated with ‘Pending’, CMA Assignment Created Date (field #99)
will be populated with the date that the reportable CMA assignment was created.
ii. When field #78 is populated with ‘Active’, CMA Assignment Created Date (field #99) will
be populated with the date that the reportable CMA assignment was created and CMA
Assignment Start Date (field #100) will be populated with the date that the CMA
assignment moved from ‘Pending’ to ‘Active’.
iii. When field #78 is populated with ‘Ended’ or ‘Rejected’, CMA Assignment Created Date
(field #99) will be populated with the date that the reportable CMA assignment was
created, and CMA Assignment Start Date (field #100) with the date that the CMA
assignment moved from ‘Pending’ to ‘Active’, if applicable, and CMA Assignment End
Date (field #101) with the date that the pending CMA assignment was ‘Rejected’ or the
date that the pending or active CMA assignment was ‘Ended’.
7. End Reason Comment (field #97) and Rejection Reason Comment (field #98)
a. If the downloading provider is a HH, these fields will be populated with any comments provided
if a CMA user ended or rejected the member’s assignment and this overlapped at least one day
with the downloading provider’s HH assignment. If no comment was added when the CMA
ended/rejected the assignment, or no assignment was ended/rejected, these fields will be blank.
b. If the downloading provider is a VFCA CMA these fields will be populated with any comments
provided by a HH user who ended or rejected the member’s assignment, and this overlapped at
least one day with the downloading provider’s CMA assignment. If no comment was added when
the HH ended/rejected the assignment or no assignment was ended/rejected these fields will be
blank.
c. If the downloading provider is a non-VFCA CMA these fields will be blank.
8. Rejected Assignment Suggested Alternative Assignment (field #102)
a. This field will only be populated when a HH user downloads the file and a CMA has rejected a
pending assignment and suggested another CMA assignment and this rejection overlaps with the
downloading providers HH assignment.
9. HH Assignment Record Type (field #93)
a. If the user is downloading on behalf of a HH, this field is always populated with the record type of
the ‘Pending’ or ‘Active’ HH assignment record.
b. If the user is downloading on behalf of a VFCA CMA, this field will only populate when the
member also has an ‘Active’ HH assignment with the record type of the active HH assignment
record.
c. If the user is downloading on behalf of a non-VFCA CMA, this field will always be populated with
the record type of the ‘Active’ HH assignment record.
10. HH Assignment Start Date (field #94) is always populated if the member has an ‘Active’ HH assignment
record. If the member had a ‘Pending’ HH Assignment record, then this field will be blank.
11. MCP Assignment Fields
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a. MCP Assignment Record Type (field #95) and MCP Type (field #96) are populated when a
member has an ‘Active’ assignment record with an MCP.
b. MCP Assignment Created Date (field #103) is populated with the create date of the active MCP
assignment, if the member has an MCP assignment.
c. MCP Assignment Start Date (field #104) is populated with the start date of the active MCP
assignment, if the member has an MCP assignment.
12. Fields Relating to Member’s Most Recent Segment Information (#105-110)
a. The system will populate fields #105-110 with the most recent segment information (for any
segment that is in a non-cancelled or non-hiatus status) for any member regardless of if the
organization involved in the segment is associated with the downloading provider.
b. Outreach/Enrollment Code (field #105) specifies If the most recent segment the member had
was an outreach or an enrollment segment.
c. HH MMIS ID (field #106) and HH Name (field #107) list the Health Home information associated
with the member’s most recent segment.
d. Segment End Date (field #108), Segment End Date Reason Description (field #109), and
Segment End Date Reason Comments (field #110) provide further information as to why the
most recent segment ended.
i. Providers are expected to use this information to determine if the member assignment
should be accepted or rejected and/or if the member should be assigned downstream.
For example, should a HH see a member on this file with a Pending HH Assignment
Status(field #74) they should review fields #105-110 to determine if they may work with
this member
1. If they see that the member had a previous Enrollment Segment field #105 with
a Segment End Date Reason Description of (field #109) ‘Member interested in
HH at a future date’ and a Segment End Date (field #108) in the last 2 weeks
they would know that it is not appropriate to accept the pending assignment
for this member at this time and instead they would reject the member
assignment.
2. If they see that the member had a previous Enrollment Segment field #105 with
a Segment End Date Reason Description (field #109) of ‘Member dissatisfied
with services’ with a Segment End Date Reason Comment (field #110) of “mbr
requesting to work with a different HH” the HH would know that they should
accept the assignment and assign to a downstream CMA.
13. Eligible for Outreach (field #111) and No of Outreach Mos Within 12 months (field #112) provide
information as to whether or not a member meets the 2 in 12-month outreach threshold that was
implemented in October of 2017. Effective 7/1/20, outreach is no longer a Medicaid covered service.
a. Eligible for Outreach (field #111) will display a N if a member has 2 or more months of
outreach in a status other than Cancelled or Hiatus within the last 12 months. If the member
has 1 or less months of outreach in a status other than Cancelled or Hiatus the field will
display a Y.
b. No of Outreach Mos Within 12 mos (field #112) displays a count of number of months of
outreach in a status other than Cancelled or Hiatus for the member.
i. The 12-month periods are based on the date the file is downloaded. The month that the
user is downloading the file is included in the 12-month count. For example, if a
provider downloads the file on 12/10/2017 the system will calculate the # of months of
outreach the member had between 1/1/17 and 12/31/2017.
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ii. Providers should use the data in these 2 fields as well as any new information that they
have regarding a member to determine if it is appropriate to outreach to this member at
the time.
14. Use the Member’s Date of Birth (field #4) to determine if an assignment is for a child or an adult.
15. Child HCBS Flag (field #113)
a. For children referred into the program on or after 1/10/19 this field is populated based on the
referral rationale selected during the referral process in the CRP. Children referred into the
program prior to 1/10/19 have a record with a blank value in this field. Adults have a record with
a blank value in this field both prior to and after 1/10/19
ii. The system will populate the field with “Y” if “HCBS Only” was selected for the member
on the Referral Rationale Screen in the CRP.
iii. The system will populate the field with “H” if “Chronic Conditions and HCBS” was
selected for the member on the Referral Rational Screen in the CRP.
iv. The system will populate the field with “N” if “Chronic Conditions Only” was selected for
the member on the Referral Rationale Screen on the Referral Rational Screen in the CRP
16. Fields Relating to Suggested Providers Selected during a Child Referral (fields #114-117)
a. The system will populate these fields based on a referrer’s responses when referring a child via
the CRP.
b. If the member was not referred, was referred using the Adult Referral Wizard/File, was a child
referred prior to 1/10/19, was entered directly into a segment, or the referrer did not select a
suggested provider, these fields will be blank.
17. If the member has had multiple referrals where suggested providers were selected the system will display
the most recently suggested provider information.
18. Fields Relating to Transfers (fields #119-126) will be populated to either indicate that the downloading
provider has to act on a transfer (pending value in assignment status field) or to notify the provider that a
transfer that the downloading provider requested was rejected (rejected value in assignment status
field).If a CMA is downloading the file, then the transfer related fields are populated only if there is a
pending transfer for the CMA’s member.
a. Please refer to the transfer guide titled “Transfer System Logic’ and found under the Health
Home Tracking System tab on the MAPP HHTS portion of the HH website found here:
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/mapp/inde
x.htm
b. Thirty days after a pending transfer is rejected, the rejected transfer record will be canceled and
will no longer appear on the initiating Health Home’s assignment file.
Past Assignments
Description
The Past Assignments file includes members who were assigned to the downloading user’s organization, but
whose assignments with the user’s organization were ended/rejected without resulting in segments. This file
contains assignments with the downloading provider that have an end date within the past year.
The purpose of this file is to explain to providers why a member assignment that did not result in a segment was
ended and is no longer included in the provider’s assignment file. This file includes member assignments that were
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rejected by the provider, member assignments ended by the provider, member assignments that ended because
something about the member changed, which triggered the member’s removal from the provider’s assignment
file, and members that were purged from the system due to inactivity.
Please note that this file only includes members that were assigned to a provider and whose assignment did not
result in a segment with the provider. For example, John was assigned to HH B by MCP A. HH B then enrolled John
on 6/1/16. As a result, the system ends the existing reportable assignment to create the enrollment segment.
Although John’s assignment was ended with HH B on 5/31/16, John will not be included on HH B’s Past Assignment
file, because John’s assignment with HH B ended because HH B created a segment, which excludes him from being
included on the Past Assignments file. If a user from HH B needs to determine why John, or any other member
with a closed segment with HH B, is no longer assigned to HH B, then the user should download the Enrollment
Download file and review the record’s Segment End Date Reason Code. However, if John was assigned to HH A by
MCP A and then HH B enrolled John on 1/1/17 using an R code, then John would appear in HH A’s Past Assignment
Download because HH A’s assignment did not result in a segment with HH A. The Past Assignment file also includes
members that were purged from a provider’s assignment file due to inactivity. Although all members purged for
inactivity are purged while in an assignment status, they may have had a previous segment with the downloading
provider and still appear on the Past Assignments Download file.
Format
Past Assignments Download File
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Member First Name 1 30 30 Y Alpha
2 Member Last Name 31 30 60 Y Alpha
3 Member ID 61 8 68 Y AA1111A, Alphanumeric
4 DOB 69 8 76 Y MMDDYYYY, Numeric
5 Assignment Start Date 77 8 84 Y MMDDYYYY, Numeric
6 Assignment End Date 85 8 92 C MMDDYYYY, Numeric
7 Assignment End Date Reason Code 93 2 94 C Alphanumeric
8 Assignment End Reason Description 95 40 134 C Alpha
9 Assignment Rejection Date 135 8 142 C MMDDYYYY, Numeric
10 Assignment Rejection Reason Code 143 2 144 C Alphanumeric
11 Assignment Rejection Reason Description
145 40 184 C Alpha
12 Assignment Created Date 185 8 192 Y MMDDYYYY, Numeric
13 Last Modified Date 193 8 200 Y MMDDYYYY, Numeric
Editing Logic
A member can be removed from an assignment file for a number of reasons, including:
1. Member is no longer Medicaid eligible.
2. Assigning entity changed the member’s assignment
a. Member switched MCP status (see #6)
b. When MCP changes a plan enrolled member’s HH assignment or when DOH changes the HH
assignment for a fee for service member.
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c. When the HH changes a member’s CMA assignment.
3. Member’s coverage code changed to a coverage code that is incompatible with the Health Home program
(See Appendix L: Reference and Contacts for more information on incompatible coverage codes).
4. Recipient R/E code or principle provider code added to a member’s file that is incompatible with the
Health Home program (See Appendix L: Reference and Contacts for more information on incompatible
coverage codes).
5. Member started outreach or enrollment with another organization (only applies to HHs/CMAs).
6. Member switched MCP. This covers a few different situations:
a. Member moves from FFS to MCP: Rachel is an FFS member that is assigned to HH B (Rachel does
not have a segment in the system). On August 13, 2016, Rachel enrolls in MCP A. Once the
system knows that Rachel is enrolled in MCP A, the system will end date Rachel’s assignment
with HH B and will create a pending MCP assignment with MCP A. An HH B user downloading the
Past Assignments file on 8/21/16 will see that Rachel is included in the file download.
b. Member moves from one MCP to another MCP: Robert is enrolled in MCP A. On 3/5/16 MCP A
assigns Robert to HH B and then on 3/20/16, HH B assigns Robert to CMA C. On 8/1/16, Robert
enrolls in MCP F. Since Robert has changed MCPs, the system will automatically end Robert’s
MCP A assignment in addition to end dating any HH or CMA assignments that were made while
Robert was assigned to MCP A, as long Robert does not have any corresponding segments. MCP
A, HH B, and CMA C users downloading the Past Assignments file on 8/21/16 will see that Robert
is included in the file download. Since Robert is now associated with MCP F, the system will
create a pending MCP assignment for Robert with MCP F.
c. Member moves from MCP to FFS: Amy is enrolled in MCP F and MCP F assigned Amy to HH B on
June 3, 2016. On August 13, 2016, Amy leaves MCP F and becomes an FFS member. Once the
system knows that Amy is no longer enrolled in MCP F, the system will end date Amy’s
assignments with MCP F and HH B and will create a pending HH assignment with HH K, which is
Amy’s DOH Recommended assignment. Both MCP F and HH B users downloading the Past
Assignments file on 8/21/16 will see that Amy is included in the file download.
Additional file editing includes:
7. The export will not include members who are currently assigned or in an outreach or enrollment segment
with a provider but had past assignments with the provider that did not result in segments.
a. In June 2016, Larry was assigned to HH B by MCP A. In July 2016, Larry switched to MCP F, which
triggered the system to end Larry’s assignments with both HH B and MCP A and to create a
pending MCP assignment with MCP F. After reviewing Larry’s information, MCP F decides that
HH B is the best assignment for Larry and assigns Larry to HH B. Although Larry’s past
assignment ended with HH B in June, since he is currently assigned to HH B, Larry will not be
included in HH A’s Past Assignment file.
8. The export will not include members’ assignments that ended because the HH ended the member’s HH
assignment by responding ‘Yes’ to the “End HH Assignment?” question when end dating the member’s
outreach or enrollment segment.
9. An ended member assignment WILL BE included on this file if a segment was created for the member and
then that segment was canceled, as long as the member does not have another segment with the
provider.
a. Rita was assigned to HH B and HH B accepted the assignment in June 2016. On July 10, 2016, HH
B submitted an enrollment segment into the system for Rita. On July 12, 2016 HH B realized that
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Rita’s enrollment segment was submitted in error, so HH B submitted a delete record using the
Tracking File Delete Record file on July 15, 2016. In August 2015, Rita’s coverage code changed
to a coverage code that is not compatible with the Health Home program. Even though HH B
submitted a segment for Rita to the system, Rita will be included on HH B’s Past Assignment file
because HH B deleted Rita’s segment, which placed it in the canceled status and because the
segment was not related to the reason that Rita’s assignment with HH B ended.
b. Rita’s assignment with HH B would not appear in HH B’s Past Assignment Download if HH A
created a retroactive segment that completely overlapped HH B’s assignment.
10. There will be one row for each member. If a member falls off the assignment file, comes back on the
assignment file, and falls off again, only the latest instance will appear in the file.
Program Participation Files Program Participation Files allow MCP, HH and CMA workers to collect and view information relating to a
member’s decision to opt out of the Health Home program. Information can be collected and stored for members
currently in the MAPP HHTS as well as members with valid Medicaid IDs that have had no history in the MAPP
HHTS.
Program Participation Upload File
Description
MCP, HH, and CMA workers have the capability to upload this file to create, end, or cancel an opt-out record for a
member for whom they have a signed opt out form. MCPs can submit information for any member associated with
their MCPs. HHs and CMAs can submit information for any member with a valid Medicaid ID regardless of their
association with the uploading organization in MAPP HHTS.
Format
Program Participation File
Field # Field Start Pos Length
End Pos Format
1 Record Type 1 1 1 Character (C/E/D)
2 Member ID 2 8 9 AA11111A, Alphanumeric
3 Opt-Out Signature Date 10 8 17 MMDDYYYY, Numeric
4 Opt-Out Reason 18 2 19 Numeric
5 Opt-Out End Date 20 8 27 MMDDYYYY, Numeric
Editing Logic
1.When submitting a ‘C’ or create record in Record Type (field #1), fields 2-4 must also be populated.
a. A create record will only be accepted if the member does not have a segment that is currently active or
if the member has a segment with an end date that is the same month as the Opt-out Signature Date month
submitted on the file.
2. When submitting an ‘E’ or end record, the Member ID (field #2), Opt-Out Signature Date (field #3) that
matches the original record, and the Opt-Out End Date (field #5) must also be populated.
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3. When submitting a ’D’ or delete record the Member ID (field #2) and the Opt-Out Signature Date (field #3)
that matches the original record must be populated.
Program Participation Error Report
Description
This file is created upon validating or processing a Program Participation file containing at least one error. A
Program Participation Error Report file will not be created for an uploaded Program Participation file that does not
contain rejected records. The Program Participation Error Report file will contain one record for each record in the
uploaded Program Participation file that contains an error.
Format
Program Participation Error Report
Field # Field Start Pos Length
End Pos Format
1 Line Number 1 6 6 Numeric
2 Member ID 7 8 14 AA11111A, Alphanumeric
3 Error Reason 15 30 44 Alphanumeric
Editing Logic
This error report contains one Error Reason field. If a record fails multiple validations, it will display the first error
for the record. For a complete list of the error codes and error code descriptions used in this file, please see
Appendix B: File Error Reason Codes.
Program Participation Download File
Description
MCP, HH and CMA workers have the capability to download this file to view their members that have opt-out
records. MCP will be able to view all members associated with their MCP in MDW when downloading this file.
HH/CMAS will see members that have a HH/CMA assignment that overlaps the opt-out period as well as members
that have had an opt-out record submitted from the downloading organization.
Format
Program Participation Download File
Field # Field Start Pos Length
End Pos Format
1 Member ID 1 8 8 AA11111A, Alphanumeric
2 Opt-Out Signature Date 9 8 16 MMDDYYYY, Numeric
3 Opt-Out Submission Date 17 8 24 MMDDYYYY, Numeric
4 Opt-Out Effective Date 25 8 32 MMDDYYYY, Numeric
5 Opt-Out End Date 33 8 40 MMDDYYYY, Numeric
6 Opt-Out Reason 41 2 42 Numeric
7 Opt-Out Reason Description 43 50 92 Alphanumeric
8 Opt-Out Submitted by Organization Name
93 40 132 Alphanumeric
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Program Participation Download File
Field # Field Start Pos Length
End Pos Format
9 Opt-Out Submitted by Organization MMISID
133 8 140 Alphanumeric
Editing Logic
1. Member ID (field #1), Opt-Out Signature Date (field #2), Opt-out Reason (field #6), and Opt-out Reason
Description (field #7) are populated based on the information submitted in the Program Participation Upload file.
2. Opt-out End Date (field #5) will be populated based on the information submitted in the Program Participation
Upload File. If the user does not populate an end date the system will stamp an end date on the opt-out record
based on the Opt-out Reason (field #6) as follows:
a. “Member Not Interested: No-Follow-Up”: No end date
b. “Member Not Interested: Follow-up in Three Months”: start date + 90 days
c. “Member Not Interested: Follow-Up in Six Months”: start date + 180 days
2. Opt-Out Submission Date (field #3) is a system calculated date, based on the day the file was uploaded into the
system.
3. The system will calculate Opt-Out Start Date (field #4), which is the first of the month following the Opt-out
Signature Date (field #2).
Consent Files Consent files allow users to create, modify, withdraw, and access consent information for all their members,
regardless of age. Prior to submitting a Tracking File Segment Record to create an enrollment segment for an
assigned member working with an HH serving children or a member younger than 18 that is working with an HH
serving adults, a user MUST FIRST submit the Consent Upload File to establish consent to enroll for this member.
The Consent Upload File is also used to submit consent for all other members, but consent does not have to be
submitted to the system before creating a segment for members 21 and older or members 18 years and older who
are being served by an adult HH. This file also contains plan of care dates.
Consent Upload File
Description
HHs/CMAs upload this file to ‘C’ create, ‘M’ modify, and ‘W’ withdraw consent for all members, regardless of age.
MCPs cannot upload this file. Additionally, this file allows HH users to create and delete Plan of Care records for
members. Please see Appendix M: Consent File Codes for the codes used in this file and for a link to additional
information regarding consent rules for members under 21.
The Consent Upload file can only be used to upload consent information for members that are already known to
the system. When creating a new segment for members 21 and older, upload consent to enroll for that member
using the Tracking File Segment Records file, not the Consent Upload file.
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Format
Consent Upload
Field #
Field Start Pos
Length End Pos
Req'd Format
1 Record Type 1 1 1 Y Alpha (C, M, W, P, D)
2 Member ID 2 8 9 Y AA11111A, Alphanumeric
3 HH MMIS Provider ID 10 8 17 Y Numeric
4 Existing Start Date 18 8 25 C MMDDYYYY, Numeric
5 New Start Date 26 8 33 C MMDDYYYY, Numeric
6 End Date 34 8 41 C MMDDYYYY, Numeric
7 Consenter 42 2 43 C Numeric (01, 02, 03, 04, 05, 06)
8 Existing Consent Type 44 2 45 C Numeric (01, 02, 03, 04)
9 New Consent Type 46 2 47 C Numeric (01, 02, 03, 04)
10 Plan of Care Date 48 8 55 C MMDDYYYY, Numeric
Editing Logic
1) There is no hierarchy related to the processing of the Consent Upload File by Record Type (‘C’, ‘M’, ‘W’,
‘P’, ‘D’). Records will be processed according to how they are entered into the file starting with the first
record entered. Record Types C, M, and W pertain to consent information. Record Types P and D pertain
to POC information. If a user would like to upload both consent information and plan of care information
for the same member they must submit 2 records.
2) When Record Type is ‘C (Create Consent)’, the following fields are required:
a. Record Type (field #1)
b. Member ID (field #2)
c. HH MMIS ID (field #3)
d. New Start Date (field #5)
e. Consenter (field #7)
f. New Consent Type (field #9)
g. For a provider to submit a ‘C’ record, the member must have an active or pending assignment
with the uploading provider.
3) When Record Type is ‘W’ (withdraw Consent), the following fields are required:
a. Record Type (field #1)
b. Member ID (field #2)
c. HH MMIS ID (field #3)
d. Existing Start Date (field #4)
e. End Date (field #6)
f. Existing Consent Type (field #8)
g. Member must have an existing corresponding consent record (see #9) in the system with the
uploading provider.
4) When Record Type is ‘M’ (modify consent), the following fields are required:
a. Record Type (field #1)
b. Member ID (field #2)
c. HH MMIS ID (field #3)
d. Existing Start Date (field #4)
e. Existing Consent Type (field #8)
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f. Member must have an existing corresponding consent record (see #9) in the system with the
uploading provider.
5) When Record Type is ‘P (Create Plan of Care)’, the following fields are required:
a. Record Type (field #1)
b. Member ID (field #2)
c. Plan of Care Date (field #10)
d. User must be a Health Home user to enter POC information. The user should not enter HH MMIS
ID (field #3), if they enter this information the record will error.
6) When Record Type is ‘D’ (Delete Plan of Care), the following fields are required:
a. Record Type (field #1)
b. Member ID (field #2)
c. Plan of Care Date (field #10)
d. HH uploading the file must have an existing Plan of Care date for the member.
User must be a Health Home user to delete POC information. The user should not populate the HH MMIS
ID (field #3). If HH MMIS ID (field #3) is populated on a ‘D’ record submission, the record will error.
7) When the system processes the Consent Upload File record(s) to modify or withdraw consent, the system
will use the data entered in the Member ID (field #2), HH MMIS Provider ID (field #3), Existing Start Date
(field #4), and Existing Consent Type (field #8) fields to determine the existing consent record’s Consent
ID.
8) Consent to Enroll is required to create an enrollment segment for all members.
9) A consent record cannot be modified/withdrawn if the modification will result in an enrollment segment
that is not completely covered by a consent to enroll/adult consent date required record for all members.
The following scenarios describe modifications that the system will not allow, when Record Type is ‘M’,
Existing Consent Type is ‘01’ or ‘04’:
a. and value is entered in the Begin Date field in which the modification would make it so that no
Consent to Enroll/ Adult Consent Date Required exists that would cover the enrollment segment
period, the New Start Date cannot be after the last day of the month of the segment begin date.
b. and value is entered in the End Date field in which the modification would make it so that no
Consent to Enroll/ Adult Consent Date Required exists that would cover the enrollment segment
period, the End Date cannot be prior to the first day of the month of the segment end date.
c. and the modification would make it so that no Consent to Enroll/ Adult Consent Date Required
exists that would cover the enrollment segment period, a value cannot be entered into the New
Consent Type field when an overlapping consent exists with a start date after the last day of the
month of the consent start date.
10) Consent dates entered on the Consent Upload file cannot be in the future.
11) Consenter ‘06’ (System) is only valid with Consent Type ‘04’ (Adult Consent Date Required). This is used by
the system to ensure that all segments are covered by consent. These values are not available to
providers
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Consent Error File
Description
This file is created upon validating or processing a Consent Upload File containing at least one error. A Consent
Error file will not be created for an uploaded Consent Upload File that does not contain rejected records. The
Consent Error File will contain one record for each record in the Consent Upload File that contains an error.
Format
Consent Error File
Field # Field
Start Pos Length
End Pos Required (Y, N, C) Format
1 Record Type 1 1 1 Y Alpha (C, M, W)
2 Member ID 2 8 9 Y AA11111A, Alphanumeric
3 HH MMIS Provider ID 10 8 17 Y Numeric
4 Existing Start Date 18 8 25 C MMDDYYYY, Numeric
5 New Start Date 26 8 33 C MMDDYYYY, Numeric
6 End Date 34 8 41 N MMDDYYYY, Numeric
7 Consenter 42 2 43 Y Numeric (01, 02, 03, 04, 05, 06)
8 Existing Consent Type 44 2 45 C Numeric (01, 02, 03, 04)
9 New Consent Type 46 2 47 C Numeric (01, 02, 03, 04)
10 Plan of Care Date 48 8 55 C MMDDYYYY, Numeric
11 Error Reason 56 30 85 Y Alphanumeric
Editing Logic
The Error Reason (field #10) will be populated with a description of why the record was rejected. The field will
only contain one error description. If a record hits more than one error, only the first error will be displayed in the
Error Reason (field #10). This error file contains both file format errors and logic errors. For more information on
Consent Upload file errors, please review the Consent Upload File: Editing Logic section and Appendix B: File Error
Reason Codes.
Consent Download File
Description
This file contains all the consent records with an active, withdrawn, or ended Consent Status for a provider’s
members, regardless of how the consent was entered into the system (online, Consent Upload File, or Tracking File
Segments Record file). The file also contains submitted Plan of Care records (excluding deleted Plan of Care
records). For HH providers this is determined by the HH that uploaded the file. For CMA/MCP users the file will
display any Plan of Care information where the Plan of Care date overlaps at least 1 day with the provider’s
assignment for the member. MCPs, HHs, and CMAs can all download this file.
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Format
Consent Download File
Field # Field
Start Pos Length
End Pos
Required Consent Record (Y, N, C)
Required POC Record (Y, N, C) Format
1 Member ID 1 8 8 Y Y AA11111A, Alphanumeric
2 First Name 9 30 38 Y Y Alpha
3 Last Name 39 30 68 Y Y Alpha
4 HH MMIS Provider ID 69 8 76 Y N Numeric
5 HH Name 77 40 116 Y N Alphanumeric
6 Start Date 117 8 124 Y N MMDDYYYY, Numeric
7 End Date 125 8 132 C N MMDDYYYY, Numeric
8 Consenter 133 2 134 Y N Numeric (01, 02, 03, 04, 05, 06)
9 Consent Type 135 2 136 Y N Numeric (01, 02, 03, 04)
10 Status 137 2 138 Y N Numeric (01, 02, 03)
11 Last Updated By 139 40 178 Y Y Alpha
12 Consent Date 179 8 186 Y Y MMDDYYYY, Numeric
13 Time 187 8 194 Y Y HH:MM:SS, Numeric
14 Plan of Care Date 195 8 202 N Y MMDDYYY, Numeric
15 Plan of Care Create Date
203 8 210 N Y MMDDYY, Numeric
16 Plan of Care HH MMISS Provider ID
211 8 218 N Y Numeric
17 Plan of Care HH Name 219 40 258 N Y Alpha
Editing Logic
1) Members will have a unique record for each consent type or Plan of Care they have in the system:
a. A member with two consents to enroll records, one consent to share protected information
record and 1 plan of care date will have four records in the Consent Download file.
2) The system will populate Last Updated By (field #11) with the user name of the most recent logged in
user that created or updated the consent.
a. The system will populate Last Updated By (field #11) with a value of ‘conversion’ when the
record existed prior to December 1, 2016 and has not been updated post December 1, 2016.
3) The system will populate Date (field #12) with the most recent date the consent record was created or
updated.
4) The system will populate Time (field #13) with the most recent time the consent record was created or
updated.
5) The Consent Download file will be sorted by alphabetical ascending order (A – Z) by member last name.
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6) The system will populate Plan of Care fields (field #14-17) with the most recent plan of care information.
a. If the member has member has multiple Plan of Care Date records for the same date, the system
will display these as follows:
i. For a HH downloading the file, the system will display the Plan of Care record associated
with that HH.
ii. For an MCP or CMA downloading the file, the system will display individual line items for
all Plan of Care records that overlap with the provider’s assignment with the member
iii. For example, member AA12345A has a plan of care date with HH A of 1/1/19 and a Plan
of care date with HH B of 1/1/2019. HH A downloads the consent file and sees only the
1/1/19 plan of care. A CMA with a segment with a member starting 11/1/18 to open
downloads the file and see’s 2 lines for the member – 1 with HH A and one with HH B.
7) Deleted plan of care records will not be included on the consent file; however, all added and deleted plan
of care information will be recorded in the on the Plan of Care screen available in the Member’s case.
8) On consent records, the Plans of Care fields (#14-17) will be blank.
9) On Plan of Care records, only the following fields will be populated (all other fields will be blank).
a. Member ID (field #1)
b. First Name (field #2)
c. Last Name (field #3)
d. Plan of Care Date (field # 14)
e. Plan of Care Create Date (field # 15)
f. Plan of Care HH MMIS Provider ID (field # 16)
g. Plan of Care HH Name (field # 17)
Tracking File Records Tracking File Records are used to create, delete, pend, or modify segments and to create, reject, accept, and end
assignments. Both HHs and CMAs can submit Tracking File records to the system, but only HHs can use record
type ‘N’ to create a new assignment and record type ‘A’ to accept a pending segment. (Please refer to Appendix I:
Tracking File Record Type Codes for further information on Tracking File record types.) MCPs cannot submit
Tracking Files.
There are three different Tracking File Record upload file formats: Tracking File Segment Records, Tracking File
Assignment Records, and the Tracking File Delete Records. These three file formats can be included in one file
uploaded to the system as a Tracking File upload file (some restrictions apply) or these three file formats can be
separated out into different files uploaded to the system as Tracking File upload files.
Since Tracking File Records are used to track a member’s assignment or segment status, the files discussed in the
Tracking File Records section must be submitted at least daily WHEN AT LEAST ONE MEMBER’S STATUS HAS
CHANGED. For example, listed below is a table outlining the member status changes that occurred for HH A
members in the first week of August 2015. For each day included in the table, the File submission required?
column indicates if the HH is required to submit a file that day, depending on the member status changes that
occurred that day.
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As shown above, a daily Tracking File submission is not required if there are no changes to a provider’s members’
statuses during that day. Additionally, a provider does not have to submit a file every time a member’s status
changes during the day. For example, listed above for Wednesday 8/5/15, HH A does not need to submit a file at
10, noon, and 3:30; only one file submission for Wednesday 8/5/15 is required. Nor does HH A have to wait until
the end of the day to submit their daily file to the system, if required, as long as HH A is consistent with daily file
submission timing. For example, assuming that HH A submits a daily Tracking File every day around 3:00 pm, the
daily file submitted by HH A on Wednesday 8/5/15 would only include the 10 members that began outreach at
10:00 am and the 15 members that began enrollment at noon. The 10 members that moved from outreach to
enrollment at 3:30 pm would have to be submitted on Thursday’s 8/6/15 file submission; this would change the
table above since HH A is now required to submit a file on 8/6/15 to account for a member status change that
occurred late in the day on Wednesday 8/5/15.
PLEASE NOTE that the accuracy of the system relies on timely and accurate submissions by providers. While DOH
does not require more than one file submission in a day, providers that are able to submit more than one Tracking
File in a day are strongly encouraged to submit Tracking Files as often as possible as member statuses change
during the day. If possible, HH A is encouraged to submit a file to the system every time a member status change
warrants it; for Wednesday 8/5/15 HH A would ideally submit a file at 10:00 am, noon, and 3:30 pm to ensure that
the system is as up to date as possible.
Tracking File Assignment Records
Description
HHs use this file to accept, reject, and end member assignments made via straight referrals, either directly to the
HH or via the MCP; to create assignments for their CMAs; and to accept, reject, and end member assignments on
behalf of their CMAs. CMAs use this file to accept, reject, and end member assignments from HHs. VFCA CMAs
can also use this file to assign a Health Home. MCPs cannot upload this file.
Format
Tracking File Assignment Records
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Record Type 1 1 1 Y Alpha (S, R, E, N)
Determining Daily Tracking File Submission Requirement
Date Member Status Changes File submission required?
Sunday, August 02, 2015 No change No
Monday, August 03, 2015 Accepted 1,000 pending assignments from MCP A Yes
Tuesday, August 04, 2015 No change No
Wednesday, August 05, 2015
Started 10 members in O at 10:00 am, 15 in E at
noon, and moved 10 from O to E at 3:30 pm Yes
Thursday, August 06, 2015 No change No
Friday, August 07, 2015
Need to reject 5 pending assignments from MCP B
and need to delete 1 member segment submitted in
error Yes
Saturday, August 08, 2015 No change No
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Tracking File Assignment Records
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
2 Member ID 2
8 9 Y AA11111A, Alphanumeric
3 Rejection Reason 10 2 11 C Numeric
4 Suggested Alternate Assignment 12 8 19 C Numeric
5 Rejection Reason Comment 20 40 59 C Alphanumeric
6 CMA MMIS Provider ID 60 8 67 C Numeric
7 End Date Reason 68 2 69 C Alphanumeric
8 End Date Reason Comment 70 40 109 C Alphanumeric
9 End HH Assignment 110 1 110 Y Alpha (Y/N)
10 HH Provider MMIS ID 111 8 118 C Numeric
Editing Logic
1. For an HH to submit this file on behalf of a CMA, the HH must have an active assignment with the
member and must have an active relationship with the CMA as of the file submission date, or the
records associated with the CMA in the file will be rejected.
2. Unless otherwise stated, if a record contains values in fields that do not apply to the submitted
record type, the system will accept the record but will ignore the values in the fields that don’t apply
to the record type
a. Values submitted in the fields below for record types ‘S’ (Accept Assignment) and ‘N’ (New
Assignment) will be ignored by the system
i. Rejection Reason (field #3)
ii. Suggested Alternate Assignment (field #4)
iii. Rejection Reason Comment (field #5)
iv. End Date Reason (field #7)
v. End Date Reason Comment (field #8)
b. Values submitted in the fields below for record type ‘R’ (Reject Assignment) will be ignored
by the system
i. End Date Reason (field #7)
ii. End Date Reason Comment (field #8)
c. Values submitted in the fields below for record type ‘E’ (End Assignment) will be ignored by
the system
i. Rejection Reason (field #3)
ii. Suggested Alternate Assignment (field #4)
iii. Rejection Reason Comment (field #5)
3. Record Type ‘R’ (Reject Assignment) is used by HHs to reject pending assignments, by HHs to reject a
pending CMA assignment that the HH made to a CMA on behalf of that CMA, and by CMAs to reject
pending assignments made to the CMA by an HH.
a. Rejection Reason (field #3) and End HH Assignment (field #9) must be populated with an
accepted value on all ‘R’ records or the record will be rejected.
i. When an HH submits an ‘R’ record to reject an MCP or a DOH assignment, End HH
Assignment (field #9) should be populated with a value of ‘Y’.
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ii. When an HH submits an ‘R’ record to reject a pending CMA assignment on behalf of
the HH’s CMA, End HH Assignment (field #9) should be populated with a value of
‘N’.
iii. When a CMA submits an ‘R’ record, the End HH Assignment field must be
populated with a value of ‘N’. If End HH Assignment (field #9) is populated with a
value of ‘Y’, then the record will be rejected.
b. Once an ‘R’ record type is processed, the system will populate the member’s appropriate
assignment status as ‘Rejected’ to signal to the provider that created the assignment that
the assignment was rejected (HH assignment status to rejected from the MCP/DOH
perspective or CMA assignment status to rejected from the HH perspective), will populate
the rejection reason within the system with the value listed in the Rejection Reason (field
#3), and will record into the member’s case the Suggested Alternate Assignment (field #4)
value, if submitted. This information is available to the provider either on screen or via the
MCP/HH assignment download.
i. Angela is enrolled in MCP A. The MCP identified Angela as a potentially HH eligible
member on July 3, 2016. MCP A assigned Angela to HH B on July 15, 2016, who
rejected her pending HH assignment on August 2, 2016 because Angela lives
outside of HH B’s service area and listed HH C (MMIS Provider ID: 01234567) as a
suggested HH assignment. Listed below is how MCP A and HH B will see Angela on
their assignment files after HH B rejects the assignment created by MCP A:
1. MCP A– Angela will be listed on the MCP Assignment file with an active
MCP assignment, a value of ‘07152016’ (7/15/16) in HH Assignment
Created Date (field #8), a value of ‘07032016’ (7/03/16) in MCP
Assignment Created Date (field #72), a value of ‘01234567’ in Rejected
Assignment Suggested HH Assignment(field #78), and a value of ‘Rejected’
in Health Home Assignment Status (field #77). The HH Rejection Reason
Code and Description will also be displayed.
2. HH B– Angela will no longer be listed on HH B’s Health Home Assignment
file since HH B no longer has an assignment with Angela. Angela will be
listed on HH B’s Past Assignment file with a value of ‘07152016’ (7/15/16)
in Assignment Created Date (field #12), a value of ‘08022016’ (8/2/16) in
the Assignment Rejection Date (field #9), a value of ‘02’ in Assignment
Rejection Reason Code (field #10), and a value of ‘Member moved out of
service county’ in Assignment Rejection Reason Code Description (field
#11). Please refer to Appendix E: Assignment Rejection Reason Codes.
Assignment Start Date (field #5) will remain blank because the pending
assignment never moved into the active status and therefore does not
have a start date.
c. When an HH is rejecting an assignment, CMA Provider ID (field #6) must be blank and the
member must have a pending HH assignment status.
d. If the HH is rejecting an assignment that the HH made to its CMA on behalf of that CMA,
CMA Provider ID (field #6) must be populated with that CMAs MMIS Provider ID, the
member must have a pending assignment with that CMA, and the member must have an
active assignment with the HH submitting the file.
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4. Record Type ‘E’ (End Assignment) is used by HHs to end an active assignment, by HHs to end an
active CMA assignment, and by CMAs to end an active or pending assignment made to the CMA by an
HH.
a. End Date Reason (field #7) and End HH Assignment (field #9) must be populated on all ‘E’
records with an accepted value or the record will be rejected.
i. When an HH submits an ‘E’ record to end an active Health Home assignment, End
HH Assignment (field #9) must be populated with a value of ‘Y’.
ii. When an HH submits an ‘E’ record to end a CMA assignment, but the HH would like
to keep their active HH assignment with the member, End HH Assignment (field #9)
must be populated with a value of ‘N’.
iii. When an HH submits an ‘E’ record to end a CMA assignment and would also like to
end their active HH assignment with the member, End HH Assignment (field #9)
must be populated with a value of ‘Y’.
iv. When a CMA submits an ‘E’ record, End HH Assignment (field #9) must be
populated with a value of ‘N’.
b. A member assignment can only be ended if the member does not have an active, pending
active, pended, pending pended, hiatus, pending cancelled, or pending closed segment
associated with the assignment.
c. If an HH submits a record type of ‘E’ and CMA Provider ID (field #6) does not contain a value,
then End HH Assignment (field #9) must contain a value of ‘Y’.
d. Both HHs and CMAs can end a CMA assignment, but a CMA cannot end an HH assignment.
When a CMA submits an ‘E’ record type, End HH Assignment (field #9) must contain a value
‘N’.
e. When an HH is ending an assignment made to the HH the CMA Provider ID (field #6) must
be blank and the member must have an active HH assignment status.
f. When an HH is ending a CMA assignment that the HH made to the CMA, the CMA Provider
ID (field #6) must be populated with that CMAs Provider ID and the member must have an
active or pending assignment with that CMA.
5. Record Type ‘S’ (Accept Assignment) is used by HHs to accept a pending assignment made to the HH,
is used by HHs to accept a pending CMA assignment made by that HH to the CMA on behalf of that
CMA, and is used by CMAs to accept pending assignments made to the CMA by an HH or used by
VFCA CMAs to accept pending assignments made by LGU/SPOAs.
a. End HH Assignment (field #9) must be populated with a value of ‘N’ when submitting an ‘S’
record or the record will be rejected.
b. Once this file is processed, the system will move the member’s assignment status from
pending to active.
c. For an HH to accept a pending assignment made to the HH by an MCP or DOH, the HH must
submit an ‘S’ record with a value of ‘N’ in End HH Assignment (field #9) and the CMA
Provider ID (field #6) must be blank.
d. For an HH to accept a pending CMA assignment made by the HH on behalf of that CMA, the
HH must submit an ‘S’ record with the ID of the CMA that the HH is accepting the assignment
on behalf of in CMA Provider ID (field #6) and End HH Assignment (field #9) must be
populated with a value of ‘N’.
e. For a CMA to accept a pending CMA assignment, the CMA must submit an ‘S’ record with a
value of ‘N’ in End HH Assignment (field #9) and the CMA Provider ID (field #6) must be
blank.
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6. Record Type ‘N’ (New Assignment) is used by HHs to assign a member to a CMA, to reassign a
member from one CMA to another, or by a VFCA CMA to assign a member to a HH
a. HHs can create a new assignment using the ‘N’ record for members:
i. That have an active HH assignment
ii. That have a pending HH assignment
iii. FFS adult members that are not currently in the system with an assignment
iv. HHs cannot submit an ‘N’ record for MCP members that do not have an active or
pending assignment with the HH.
b. VFCA CMAs can create a new assignment using the ‘N’ record for members:
i. That have an active or pending CMA assignment
ii. That currently don’t have a HH assignment or to re-assign to a new HH
c. Only HHs and CMAs with a type of Foster Care can submit record type ‘N’. If a non-foster
care CMA submits a record type of ‘N’, the record will be rejected.
d. To assign a member to a CMA, the HH must submit an ‘N’ record type and enter the ID of
the CMA that the HH is assigning the member to in CMA Provider ID (field #6) (the HH and
CMA must be listed within that system as having an active relationship as of the file
submission date) and End HH Assignment (field #9) must be populated with a value of ‘N’.
This will create a pending assignment for the CMA listed in CMA Provider ID (field #6).
i. If the member had an active HH assignment, then submitting this file will create a
pending CMA assignment.
ii. If the member had a pending HH assignment, then submitting this file will create an
active HH assignment and a pending CMA assignment.
iii. If a HH submits an ‘N’ record for a member that is enrolled in an MCP and does not
yet have an HH assignment, then the system will reject the record. If an HH would
like an MCP enrolled member to be assigned to their HH, then the HH should either:
1. Refer the member to their Health Home in the system using the referral
wizard (this action is only available online), which will create a pending
referral for the member’s MCP that will be included on the MCP’s
Managed Care Plan Assignment file with the HH’s MMIS Provider ID listed
in Rejected Assignment Suggested HH Assignment (field #78), OR
2. Call the MCP and ask that the MCP assign the MCP enrolled member to the
HH.
iv. If a HH submits an ‘N’ record for a child member that they don’t currently have a
relationship with in the system, then the system will reject the record. If the HH
would like to work with Child Member they should either:
1. Make a straight referral within the MAPP HHTS Children’s Referral Portal
and request that the MCP assign the child member to them OR
2. Make an outreach or enrollment referral within the MAPP HHTS Children’s
Referral Portal with their HH.
e. To reassign a member in either an active or a pending CMA assignment from one CMA to
another CMA, the HH must submit an ‘N’ record type and enter the ID of the new CMA that
the HH wants to reassign the member to in the CMA Provider ID (field #6). This will end the
member’s assignment with the original CMA and create a pending assignment for the new
CMA listed in the CMA Provider ID (field #6).
f. To end a pending or active CMA assignment that the HH previously submitted without
creating a new CMA assignment, that HH must submit an ‘E’ record type and populate the
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CMA ProviderID (field #6) and submit a value of ‘N’ in End HH Assignment (field #9). This
will end the member’s assignment with the original CMA. This will not create a new CMA
assignment, nor will it affect the member’s active HH status.
g. The system will not allow a HH to assign a member to a CMA with which the member
already has a pending or active CMA assignment.
h. If a HH submits an ‘N’ record type with a different CMA then the CMA that the member is
currently assigned to, the system will end the member’s current CMA assignment as of the
date the file was uploaded with reason ‘Changed CMA’ and will create a pending CMA
assignment the CMA listed in CMA Provider ID (field #6) with a create date of the date that
the file was uploaded.
7. When an HH is acting on behalf of a CMA
a. The system will validate that the HH uploading the file is appropriately associated with both
the member (member has an active or pending assignment with the HH) and the CMA and
that the member has the appropriate status with the CMA ID listed in CMA Provider ID (field
#6) to perform the action.
b. For example, if HH B submits an ‘R’ record with CMA C in CMA Provider ID (field #6), the
system will make sure that the member has a pending assignment with CMA C, that HH B
has a contract with CMA C, and that HH B has an active HH assignment with the member.
8. The Suggested Alternate Assignment (field #4) is not a required field. However, when Suggested
Alternate Assignment (field #4) contains a value, that value must be a valid MMIS provider ID set up
within the system as either an HH or a CMA. If an HH user is uploading the file with record type ‘R’
and the CMA Provider ID (field #6) is blank, any ID submitted in Suggested Alternate Assignment
(field #4) must be associated with an HH in the system, or the record will be rejected. If an HH user is
uploading the file with record type ‘R’ and the CMA Provider ID (field #6) is populated, the ID
submitted in Suggested Alternate Assignment (field #4) must be associated with an existing CMA in
the system. If a CMA user is uploading the file with record type ‘R’, any ID submitted in the
Suggested Alternate Assignment must be associated with an existing CMA in the system.
Tracking File Segment Records
Description
HHs use this file to create, modify, pend or accept outreach and enrollment segments and CMAs use this file to
create, modify, or pend outreach and enrollment segments. HHs and CMAs can use this file to accept or delete
pending referrals for adult members. MCPs cannot upload this file. Please review the new logic listed in the
Editing Logic section for system logic that only applies to members under 21.
Format
Tracking File Segment Records
Field # Field
Start Pos Length
End Pos Req'd Source Format
1 Record Type 1 1 1 Y HH/CMA Alpha (C/A/M/P)
2 Member ID 2 8 9 Y HH/CMA AA11111A, Alphanumeric
3 Date of Birth 10 8 17 Y HH/CMA MMDDYYYY, Numeric
4 Gender 18 1 18 Y HH/CMA Alpha (M/F)
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Tracking File Segment Records
Field # Field
Start Pos Length
End Pos Req'd Source Format
5 Begin Date 19 8 26 Y HH/CMA MMDDYYYY, Numeric
6 End Date 27 8 34 C HH/CMA MMDDYYYY, Numeric
7 Outreach/Enrollment Code 35 1 35 Y HH/CMA Alpha (O/E)
8 HH MMIS Provider ID 36 8 43 Y HH/CMA Numeric
9 CMA MMIS Provider ID 44 8 51 Y HH/CMA Numeric
10 Direct Biller Indicator 52 1 52 N HH/CMA Field no longer used
11 Adult or Child Services Provided Indicator
53 1 53 C HH/CMA Alpha (A/C)
12 TBD 2 54 1 54 N HH/CMA Character
13 Referral Code 55 1 55 C HH/CMA Alpha
14 Segment End/Pend Reason Code
56 2 57 C HH/CMA Numeric
15 Consent Date 58 8 65 N HH/CMA MMDDYYYY, Numeric
16 NYSID 66 9 74 N HH/CMA Alphanumeric
17 Segment End Date Reason Comment
75 40 114 C HH/CMA Alphanumeric
18 Pend Start Date 115 8 122 C HH/CMA MMDDYYYY, Numeric
19 Pend Reason Code 123 2 124 C HH/CMA Numeric
20 Pend Reason Code Comment
125 40 164 C HH/CMA Alphanumeric
21 End HH Assignment 165 1 165 Y HH/CMA Alpha (Y/N)
Editing Logic
1. The HH listed in HH MMIS ID (field #8) must have an active relationship with the CMA listed in CMA MMIS ID
(field #9) for the entire segment period.
In the event that the HH and CMA listed in the segment have a relationship in the system for a
portion of the segment duration (between the segment begin date and end date), either the segment
begin date and/or end date must be adjusted so that the segment occurs within the time that the HH
and CMA had a relationship, or the HH must work with DOH to modify the HH/CMA relationship
begin and end dates prior to submitting the original segment begin/end dates.
2. The system will reject a record that is attempting to take an action that has already been processed by the
system.
a. To determine if an action has already occurred, the system will compare the submitted segment to all
segments in active, pended, pending active, pending pended, pending canceled, or pending closed
status, retrieving an exact match based on the following fields: Member ID (field #2), Begin Date
(field #5), Outreach/Enrollment Code (field #7), HH MMIS ID (field #8), and CMA MMIS ID (field #9).
3. The system will ignore any values submitted on the Tracking File Segment Records file in Direct Biller Indicator
(field #10).
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4. The system will accept the Member ID (field #2) if populated with a valid CIN and:
a. Medicaid eligible as of the record Begin Date (field #5)
b. Does not have either a coverage code or a recipient R/E/PP code that is incompatible with the Health
Home program, as of the record Begin Date (field #5)
c. Does not have a segment in the system in an active, pended, pending active, pending pended,
pending canceled, or pending closed that overlaps with the begin/end dates (if applicable) included in
the record.
d. Does not have a pended MCP assignment
5. Record Type ‘C’ (Create Segment) is used by HHs and CMAs to create an outreach or an enrollment segment.
a. Segment status:
i. When a ‘C’ record type is processed into the system by a HH, the system will create an active
segment for the submitted record.
ii. When a ‘C’ record type is processed into the system by a CMA that is not set up with auto-
approval by the HH associated with the submitted segment, the system will create a pending
active segment for the submitted record.
iii. When a ‘C’ record type is processed into the system by a CMA that is set up with auto-
approval by the HH associated with the submitted segment, the system will create an active
segment for the submitted record.
iv. When a ‘C’ record type is processed into the system by a VFCA CMA, the system will create
an active segment with the identified HH on field #8 for the submitted record. The VFCA
CMA must have an active relationship with HH for the segment period.
b. If an HH uploads a ‘C’ record matching the Member ID (field #2), Begin Date (field #5),
Outreach/Enrollment Code (field #7), HH MMIS ID (field #8) of a pending transfer for the HH listed in
HH MMIS ID (field #8), and ’T’ listed in Referral Code (field # 13) the system will update the original
(transferred out) enrollment segment to closed status with the appropriate end date and will create a
new (transferred in) enrollment segment in active status with the HH and CMA submitted in the
record.
c. If a CMA uploads a ‘C’ record matching the Member ID (field #2), Begin Date (field #5),
Outreach/Enrollment Code (field #7), and CMA MMIS ID (field #9) of a pending transfer for the CMA
listed in CMA MMIS ID (field #9) and ‘T’ listed in the Referral Code (field #13), the system will update
the original (transferred out) enrollment segment to closed status with the appropriate end date and
will create a new (transferred in) enrollment segment in active or pending active status with the HH
and CMA submitted in the record.
i. Users may only respond to transfer records via file if the member is 18 or older and being
served as an adult or 21 and older.
d. The system will automatically adjust the duration of an outreach segment, if an enrollment segment
is submitted to ensure that an overlap does not occur.
i. If a ‘C’ segment is submitted to create an enrollment segment that overlaps an outreach
segment in the system AND if the HH and CMA listed on the enrollment segment match the
HH and CMA listed on the outreach segment, then the system will end date the outreach
segment with an End Date (field #6) that is the day before the submitted enrollment
segment begin date and will create a segment for the submitted enrollment record.
ii. If a ‘C’ segment is submitted to create an enrollment segment that has the same begin date
as an outreach segment in the system AND if the HH and CMA listed on the enrollment
segment match the HH and CMA listed on the outreach segment, then the system will delete
the outreach segment and will create a segment for the submitted enrollment record.
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e. End Health Home Assignment
i. When creating an enrollment segment or outreach segment with a begin date that is prior to
10/1/17 without an end date, this field must be blank.
ii. When creating a segment with an end date, this field should be populated with a value of ‘N’
if the HH would like to maintain their active assignment with the member after the segment
ends and should be populated with a value of ‘Y’ if the HH does not want to maintain their
active assignment with the member after the segment ends.
iii. When submitting an outreach segment with a begin date on or after 10/1/17 this field must
be answered even if no end date is submitted.
f. Referral Code (field #13) Editing Logic: the referral code must be populated with an ‘R’ when the
provider does not have a previous assignment with the member for the segment period. The referral
code is only accepted for members that are 21 and older. If a member is under 21, then a provider
cannot create a segment for that member unless the member has either an active or a pending
assignment with the Health Home at the time of the segment begin date.
i. HH A submits a segment for HH A and CMA B. Member is not assigned to HH A or CMA B
and is 21 years old or older.
1. Referral Code (field #13) must contain a value of ‘R’, or the record will be rejected
2. Once the segment is created, the member will have a hidden “behind the scenes”
active referral assignment record type with HH A and CMA B, where the start and
end dates will equal the segment start and end dates, but no reportable, visible
assignments with HH A and CMA B exist.
ii. HH A submits a segment for HH A and CMA B. Member is assigned to HH A but does not
have a CMA assignment and the member is any age.
1. Referral Code must be blank, or the record will be rejected
2. Once the segment is created, the member will have a hidden “behind the scenes”
active assignment record type assignment with HH A and CMA B, where the start
and end dates will equal the segment start and end dates. And a reportable, visible
HH A assignment with an end date one day prior to the segment start date exists.
iii. HH A submits a segment for HH A and CMA B on 8/5/15 with an 8/1/15 begin date. Member
is assigned to HH A and has a pending assignment with CMA C (CMA assignment creation
date = 7/18/15) and member is any age.
1. Referral Code must be blank, or the record will be rejected
2. Once the segment is created, the member will have a hidden “behind the scenes”
active assignment record type with HH A, where the start and end dates will equal
the segment start and end dates and a reportable HH A assignment with a 7/31/15
end date.
3. CMA B assignment has a hidden “behind the scenes” assignment creation date of
8/1/15. CMA C assignment has a reportable assignment with a 7/31/15 end date
and no start date (as it was never accepted).
iv. HH A submits a segment for HH A and CMA B on 8/5/15 with begin date of 8/1/15. Member
is not assigned to HH A (member is assigned to HH C) but has an active assignment with CMA
B with an assignment creation date of 7/18/15 and an assignment start date of 7/25/15 and
member is over 21.
1. Referral Code must contain a value of ‘R’
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2. Once the segment is created, member will have a hidden “behind the scenes” active
referral record type assignment with HH A with a creation date of 8/5/15 and a
start date of 8/1/15.
3. Once the segment is created, the CMA B assignment will be partitioned into two
parts: the first reportable, visible assignment is an ended assignment with a create
date of 7/18/15 and a start date of 7/25/15 with an end date one day prior to the
segment start date (7/31/15), and the second non-reportable assignment will equal
the start date (8/1/15) and end date (currently open-ended) of the segment.
4. Once the segment is created, the HH C assignment will be ended with an end date
one day prior to the segment start date.
v. HH OR CMA submits a segment for HH A and CMA B. Member is assigned (either pending or
active) to HH A and CMA B and is any age.
1. Referral Code must be blank, or the record will be rejected
2. Once the segment is created, the member will have hidden “behind the scenes”
active assignment record type with HH A and CMA B, where the start and end dates
will equal the segment start and end dates.
vi. CMA B submits a segment for HH A and CMA B. Member is not assigned to HH A or CMA B
and is over 21.
1. Referral Code must contain a value of ‘R’, or the record will be rejected
2. Once the segment is created, the member will have a hidden “behind the scenes”
active referral record type assignment with HH A and CMA B, where the start and
end dates will equal the segment start and end dates. No reportable assignment
will exist.
3. If CMA B does not have auto approval the segment will have a pending active status
HH A accepts the segment creation.
vii. CMA B submits a segment for HH A and CMA B on 8/5/15 with a begin date of 8/1/15.
Member is assigned to HH A and has a pending assignment with CMA C (CMA C assignment
creation date = 7/18/15) and member is over 21.
1. Referral code must contain a value of ‘R’
2. Once the segment is created, the member will have a hidden “behind the scenes”
active assignment record type with HH A and a reportable, visible assignment with
HH A that ended one day prior to the start of the segment (7/31/17). Member also
has an active referral record type with CMA B, where the start and end dates will
equal the segment start and end dates.
3. CMA C assignment has a reportable, visible assignment creation date of 7/18/15,
does not have an assignment start date, and has an assignment end date of
7/31/15.
viii. CMA B submits a segment for HH A and CMA B on 8/5/15 with begin date of 8/1/15.
Member is not assigned to HH A but has an active assignment with HH F with an assignment
creation date of 7/18/15 and an assignment start date of 7/25/15. CMA B has an active
assignment with member with an assignment creation date and assignment start date of
7/30/15) and member is over 21.
1. Referral Code must be blank, or the record will be rejected
2. Once the segment is created, the member will have a hidden “behind the scenes”
active referral record type with HH A with a creation date of 8/5/15 and a start date
of 8/1/15.
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3. Once the segment is created, CMA B will have a hidden “behind the scenes” active
assignment record type with a creation and start date of 7/30/15
4. Once the segment is created, the member assignment with HH F will have a
reportable, visible assignment creation date of 7/18/15, an assignment start date of
7/25/15, and an assignment end date of 7/31/15. If the member assignment with
HH F was in pending status instead of active status, member assignment with HH F
will have a creation date of 7/18/15, no assignment start date, and an assignment
end date of 7/31/15.
g. Consent Date (field #15): When newly creating an enrollment segment for a member 21 or older, you
must submit the date the member signed consent to enroll (DOH-5055) in the Consent Date field on
the Billing Support Upload file. If the consent to enroll information isn’t recorded on this file and
doesn’t already exist in the system, then the record will be rejected. When a record is adhering to
the criteria below is created for a member 21 or older, the system will create a ‘Consent to Enroll’
record for the member with the Consent Start Date = date entered into the Consent Date field;
Consent End Date= None; Consenter=Member/Self – Individual is 18 years of age or older:
i. ‘Record Type (field #1) = ‘C’
ii. Outreach/Enrollment Code (field #7) = ‘E’
iii. Referral Code (field #13) = ‘R’
6. Record Type ‘M’ (Modify Segment) is used by HHs and CMAs to modify an existing segment in the system in a
status of active, pended, pending active, pending pended, pending closed, pending canceled, closed, or hiatus.
a. To determine which existing segment in the system needs to be modified, the system will match the
following segments on the record to the segments in the system:
i. Member ID (field #2), Begin Date (field #5), Outreach/Enrollment Code (field #7), HH MMIS
ID (field #8), and CMA MMIS ID (field #9).
ii. If a provider would like to change any of the values previously submitted in the fields listed
above, the provider must either:
1. Delete the record (puts the segment into canceled status) and resubmit the
information (by creating a new segment), if the value that needs to be modified was
incorrect and never should have been submitted to the system, OR
2. End the segment and then create a new segment with the new values.
b. If a user would like to Modify a pended segment they can do so, but the system will not allow you to
enter a Pend Start Date (field #18). If the Pend Start Date (field #18) needs to be modified the user
must delete the originally pended segment and resubmit a pend record with the correct start date.
c. If a user submits the file with a Record Type of ‘M’ and the only item that differs from what is already
on file for the closed segment is the Segment End Date Reason Code (field #14), the system will
replace the current end date reason code with the one listed in the file.
d. End HH Assignment (field #21)
i. When a CMA submits a segment with an ‘M’ record type and end date is populated, End HH
Assignment (field #21) must be populated with a value of ‘N’.
ii. When a HH submits an ‘M’ record to modify a segment without an End Date (field #6), this
field must be blank, unless the modify record is an outreach segment that has a date of
service on or after 10/1/17 (see iv).
iii. When a HH submits an ‘M’ record to modify a segment with an End Date (field #6), this field
should be populated with a value of ‘N’ if the HH would like to maintain their active
assignment with the member after the segment is over and should be populated with a
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value of ‘Y’ if the HH does not want to maintain their active assignment with the member
after the segment is over.
iv. For dates of service on or after 10/1/17, if an HH or CMA submits an ‘M’ record for an
outreach segment they must enter a value in this field regardless of if the End Date (field #6)
is populated.
e. Consent cannot be modified by using this file and Record Type ‘M’. In order to modify a consent, a provider
needs to do so via the Consent File.
7. Record Type ‘A’ (Accept Segment) is used by HHs to accept a pending segment associated with the submitting
HH that was submitted by a CMA that is not set up with auto approval with the HH.
a. To determine the pending segment in the system that requires acceptance, the system will match the
segments on the submitted record to the segments in the system using the following fields: Member
ID (field #2), Begin Date (field #5), Outreach/Enrollment Code (field #7), HH MMIS ID (field #8), and
CMA MMIS ID (field #9). All other fields aside from Record Type (field #1) and End HH Assignment
(field #21) will be ignored by the system.
b. End Health Home Assignment
i. When accepting a pending active or a pending pended segment without an end date, End HH
Assignment (field #21) must be populated with a value of ‘N’.
ii. When accepting a pending active or a pending pended segment with an end date or when
accepting a pending closed segment, the submitting HH should use End HH Assignment (field
#21) to indicate to the system whether or not the active HH assignment with the member
should end. The field should be populated with a value of ‘N’ if the HH would like to maintain
their active assignment with the member after the segment is over and should be populated
with a value of ‘Y’ if the HH does not want to maintain their active assignment with the
member after the segment is over.
c. Once this file is processed, the system will remove the word pending from the member’s segment
status: Pending active becomes active; pending pended becomes pended; pending closed becomes
closed; pending canceled becomes canceled.
d. If an HH does not want to accept a pending segment, then the HH should work with the CMA to
modify or delete the pending segment.
8. Record Type ‘P’ (Pend Segment) is used by HHs and CMAs to pend an outreach or enrollment segment in an
active, pending active, pended, or pending pended status. The system allows providers the ability to pend a
segment that already has a pended or pending pended status. Follow the same guidance below to pend a
segment with a pended or pending pended status.
a. The following fields are required when pending a segment: Record Type (field #1), Member ID (field
#2), Date of Birth (field #3), Gender (field #4), Begin Date (field #5), Outreach/Enrollment Code (field
#7), HH MMIS ID (field #8), Pend Start Date (field #18), Pend Reason Code (field #19), and Pend
Reason Code Comment (field #20) (if pend reason = ‘Other’).
i. Begin Date (field #5) should be populated with the begin date of the segment that you are
pending. When pending an active segment this would be the begin date of the active
segment, when pending an already pending segment this would be the begin date of the
pended segment.
ii. Pend Start Date (field #18) should be populated with the date that you want the pended
segment to start. The pend start date must be the first of a month.
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b. If a segment is still in the active status but has an end date that will cause the segment to move into a
closed status at the end of the month, then a user will not be able to submit a ‘P’ record to pend that
segment.
c. To move a segment out of the pend status, into an outreach or enrollment segment, simply submit a
‘C’ record to start the new segment. The system will populate the pended segment End Date with an
end date that is one day prior to the date listed in the Begin Date (field #5) of the newly submitted
segment.
d. To move a segment out of the pend status, end the member’s CMA assignment and retain the
member’s HH assignment, submit an ‘M’ record with the date that the pend should end in the End
Date (field #6), populate the Segment End/Pend Reason Code (field #14) appropriately, and populate
End HH Assignment (field #21) with a value of ‘N’. This will create a subsequent assignment for the
HH with the member with a start date of the new assignment one day following the end date of the
segment (Pend Start Date (field #18) should be blank).
e. To move a segment out of the pend status while ending the member’s assignment with both the HH
and the CMA, submit an ‘M’ record with the date that the pend should end in End Date (field 6),
populate Segment End/Pend Reason Code (field #14) appropriately, and populate End HH
Assignment (field #21) with a value of ‘Y’ (Pend Start Date (field #18) should be blank).
9. Prior to submitting a ‘C’ record to create an enrollment segment for a member under 21 that is being served
as a child and there is an existing assignment with, a user must first successfully submit and process into the
system a consent to enroll record using the Consent Upload file.
10. The Adult or Child Services Provided Indicator (field #11) is only a required field if the MMIS provider ID in HH
MMIS ID (field #8) is identified in the system as serving both adults and children. If the MMIS provider ID in
the HH MMIS ID (field #8) is identified in the system as serving adults only or children only, then this field is
not required and will be ignored by the system.
a. Health Home MMIS Provider IDs that serve both adults and children must submit a value of ‘A’ in
Adult or Child Services Provided Indicator (field #11) when working with a member in their adult
program. This will indicate to the system to create an Adult HML billing instance for the member.
b. Health Home MMIS Provider IDs that serve both adults and children must submit a value of ‘C’ in
Adult or Child Services Provided Indicator (field #11) when working with a member in their children’s
program. This will indicate to the system to look for CANS NY Assessment information and to create a
children’s questionnaire billing instance for the member.
11. When an outreach segment is created for a member under 21 by an HH that either only serves children or
serves both children and adults, the system automatically assigns the member to the children’s program
regardless of the value that was submitted in Adult or Child Services Provided Indicator (field #11) by the
submitting HH or CMA.
Tracking File Delete Records
Description
The delete record is used to delete from the system an incorrectly entered outreach or enrollment segment. The
delete record should only be used to remove incorrect segment information that should never have been
submitted into the system. The Delete record is also utilized to reject a pending transfer for a member that is
being served as an adult. Both HHs and CMAs use this file to act on incorrectly submitted segments associated with
them or pending transfers that they need to act on (HH can only delete a segment if the uploading HH is listed in
the segment’s Health Home MMIS Provider ID field and a CMA can only delete a segment if the uploading CMA is
listed in the segment’s Care Management Agency MMIS Provider ID field). MCPs cannot upload this file.
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Format
Delete Record
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Record Type 1 1 1 Y Alpha (D)
2 Member ID 2
8 9 Y
AA11111A, Alphanumeric
3 Begin Date 10 8 17 Y MMDDYYYY, Numeric
Editing Logic
1. Only segments in an active, closed, pended, pending active, pending closed, or pending pended segment
status can be deleted.
2. There must be a segment record in the system that corresponds with the Member ID (field #2), the Begin
Date (field #3), and the submitting provider for the delete record to be accepted.
a. If the record is submitted by a HH, then the Begin Date (field #3) and HH uploading the file must
match the Begin Date and Health Home MMIS Provider ID of a segment in the system for the
system to accept the delete record. If successfully submitted, the member will move into a
canceled segment status.
b. If the record is submitted by a CMA, then the Begin Date (field #3) and CMA uploading the file
must match the Begin Date and Care Management Agency MMIS Provider ID of a segment in the
system for the system to accept the delete record. If successfully submitted, the member will
move into a pending canceled segment status, unless the HH associated with the segment that is
being deleted marked the CMA as “auto approved.” In that case, the HH has already indicated to
the system that the HH does not need to review/accept the CMA segment actions and therefore
the deleted record submitted by the auto approved CMA will move the segment directly into the
canceled status.
3. When rejecting a pending transfer, the user must submit a file that contains the Record Type (field #1),
Member ID (field #2) and Begin Date (field #3).
a. The Begin Date (field #3) should be populated with the effective date of the transfer.
Tracking File Error Report
Description
This file is created upon validating or processing a Tracking File Assignment Records, Tracking File Segment
Records, or a Tracking File Delete Records file containing at least one error. A Tracking Error Report file will not be
created for an uploaded Tracking File that does not contain rejected records. The Tracking Error Report file will
contain one record for each record in the uploaded Tracking File that contains an error.
Format
Tracking File Error Report
Field # Field
Start Pos Length
End Pos Req'd Source Format
1 Line Number 1 6 6 Y Gen Numeric
2 Record Type 7 1 7 C HH/CMA Alpha (C/A/M/P/D/S/R/E/N)
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Tracking File Error Report
Field # Field
Start Pos Length
End Pos Req'd Source Format
3 Member ID 8 8 15 C HH/CMA AA11111A, Alphanumeric
4 Begin Date 16 8 23 C HH/CMA MMDDYYYY, Numeric
5 HH MMIS Provider ID 24 8 31 C HH/CMA Numeric
6 CMA MMIS Provider ID 32 8 39 C HH/CMA Numeric
7 Error Reason Code 1 40 3 42 Y Gen Numeric
8 Error Reason Code 2 43 3 45 C Gen Numeric
9 Error Reason Code 3 46 3 48 C Gen Numeric
10 Error Reason Code 4 49 3 51 C Gen Numeric
11 Error Reason Code 5 52 3 54 C Gen Numeric
12 Error Description1 55 70 124 Y Gen Alphanumeric
13 Error Description2 125 70 194 C Gen Alphanumeric
14 Error Description3 195 70 264 C Gen Alphanumeric
15 Error Description4 265 70 334 C Gen Alphanumeric
16 Error Description5 335 70 404 C Gen Alphanumeric
Editing Logic
This error report contains error code fields and error code field descriptions for up to 5 errors per record. If more
than 5 errors apply to the rejected record, only the first five errors will be displayed. For a complete list of the
error codes and error code descriptions used in this file, please see Appendix B: File Error Reason Codes.
Member Downloads
Enrollment Download File
Description
The Enrollment Download file contains a record for every outreach and enrollment segment connected to the
downloading provider in the system in the following statuses: active, closed, canceled, hiatus, pended, pending
active, pending closed, pending pended, and pending canceled. This file can be downloaded by MCPs, HHs, and
CMAs.
For MCPs, this file will contain any member segments that overlaps with the period of time that the member’s
enrolled in the MCP. For HHs, this file will contain all segments that contain the downloading provider’s MMIS
Provider ID in the Health Home MMIS ID field. For CMAs, this file will contain all segments that contain the
downloading provider’s MMIS Provider ID in the Care Management Agency MMIS ID field.
When downloading the Enrollment Download File providers can select which segment statuses they would like
included in their file. This allows providers to more readily access members associated with their organization that
fit into specific categories. Providers can elect to download a file that contains all available statuses.
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Format
Enrollment Download File
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Member ID 1 8 8 Y
AA11111A, Alphanumeric
2 Begin Date 9 8 16 Y MMDDYYYY, Numeric
3 End Date 17 8 24 Y MMDDYYYY, Numeric
4 Outreach/Enrollment Code 25 1 25 Y Alpha (O/E)
5 HH MMIS Provider ID 26 8 33 Y Numeric
6 CMA MMIS Provider ID 34 8 41 Y Numeric
7 Direct Biller Indicator 42 1 42 C Alpha (Y/N/NULL)
8 Referral Code 43 1 43 C Alpha
9 Segment End Date Reason Code 44 2 45 C Numeric
10 Consent Date 46 8 53 C MMDDYYYY, Numeric
11 NYSID 54 9 62 C Alphanumeric
12 Insert Date 63 8 70 Y MMDDYYYY, Numeric
13 Latest Modified Date 71 8 78 Y MMDDYYYY, Numeric
14 Status Start Date 79 8 86 Y MMDDYYYY, Numeric
15 Status End Date 87 8 94 Y MMDDYYYY, Numeric
16 Status 95 20 114 Y Alpha (Active, Pended, Hiatus, Closed, Canceled, Pending Active, Pending Pended, Pending Closed, Pending Canceled)
17 Segment End Date Description 115 40 154 C Alpha
18 Segment Pend Reason Code 155 2 156 C Alphanumeric
19 Segment Pend Reason Description 157 40 196 C Alpha
20 HH Name 197 40 236 Y Alphanumeric
21 CMA Name 237 40 276 Y Alphanumeric
22 Member First Name 277 30 306 Y Alpha
23 Member Last Name 307 30 336 Y Alpha
24 Gender 337 1 337 Y Alpha (M/F)
25 DOB 338 8 345 Y MMDDYYYY, Numeric
26 HARP Flag 2012 346 1 346 Y Alpha (Y/N)
27 HARP Flag 2014 347 1 347 Y Alpha (Y/N)
28 HARP 348 1 348 Y Alpha (Y/N)
29 Medicaid Eligibility End Date 349 8 356 C MMDDYYYY, Numeric
30 Adult or Child Services Provided Indicator
357 1 357 C Alpha (A/C)
31 Current MCP Name 358 40 397 C Alpha
32 Current MCP MMIS Provider ID 398 8 405 C Numeric
33 Pend Reason or Segment End Date Reason Comment
406 300 705 C Alphanumeric
34 Child HCBS Flag Based on R/E Code 706 1 706 C Alpha (Y/N)
35 Transfer Initiator MMIS ID 707 8 714 C Numeric
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Enrollment Download File
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
36 Transfer Initiator Organization Name
715 40 754 C Alpha
37 Transfer Receiver MMIS Provider ID
755 8 762 C Numeric
38 Transfer Receiver Organization Name
763 40 802 C Alpha
39 Transfer Create Date 803 8 810 C Date 40 Transfer Effective Date 811 8 818 C Date 41 Transfer Reason 819 75 893 C Alpha 42 Transfer Comment 894 300 1193 C Alphanumeric
Editing Logic
The following section describes Juanita and Paul’s Health Home and Managed Care Plan affiliation over the past
few years. Each provider is then listed with the description of the segments that would be included in the
provider’s Enrollment Download file.
1. Juanita was enrolled in MCP A from January 1, 2014 through present. Juanita had an outreach segment from
1/1/14 – 2/28/14 with HH B and CMA D and then started enrollment on 3/1/14 with HH A and CMA D.
a. Outreach/Enrollment Code: O, Begin Date: 1/1/14, End Date: 2/28/14, HH B, CMA D
b. Outreach/Enrollment Code: E, Begin Date: 3/1/14, End Date: [blank], HH A, CMA D
2. Paul was a fee for service member when he started outreach with HH B and CMA C in March 2014. In April
2014, Paul became a member of MCP A and enrolled in HH B and CMA C effective 4/1/14. In May 2014, Paul
switched to MCP F. In September, Paul switched his HH B enrollment from CMA C to CMA D.
a. Outreach/Enrollment Code: O, Begin Date: 3/1/14, End Date: 3/31/14, HH B, CMA C
b. Outreach/Enrollment Code: E, Begin Date: 4/1/14, End Date:8/31/15, HH B, CMA C
c. Outreach/Enrollment Code: E, Begin Date: 9/1/14, End Date: [blank], HH B, CMA D
3. MCP A
a. Juanita Outreach/Enrollment Code: O, Begin Date: 1/1/14, End Date: 2/28/14, HH B, CMA D
b. Juanita Outreach/Enrollment Code: E, Begin Date: 3/1/14, End Date: [blank], HH A, CMA D
c. Paul Outreach/Enrollment Code: E, Begin Date: 4/1/14, End Date:8/31/15, HH B, CMA C
4. HH B
a. Juanita Outreach/Enrollment Code: O, Begin Date: 1/1/14, End Date: 2/28/14, HH B, CMA D
b. Paul Outreach/Enrollment Code: O, Begin Date: 3/1/14, End Date: 3/31/14, HH B, CMA C
c. Paul Outreach/Enrollment Code: E, Begin Date: 4/1/14, End Date:8/31/15, HH B, CMA C
d. Paul Outreach/Enrollment Code: E, Begin Date: 9/1/14, End Date: [blank], HH B, CMA D
5. CMA C
a. Paul Outreach/Enrollment Code: O, Begin Date: 3/1/14, End Date: 3/31/14, HH B, CMA C
b. Paul Outreach/Enrollment Code: E, Begin Date: 4/1/14, End Date:8/31/15, HH B, CMA C
6. CMA D
a. Juanita Outreach/Enrollment Code: O, Begin Date: 1/1/14, End Date: 2/28/14, HH B, CMA D
b. Juanita Outreach/Enrollment Code: E, Begin Date: 3/1/14, End Date: [blank], HH A, CMA D
c. Paul Outreach/Enrollment Code: E, Begin Date: 9/1/14, End Date: [blank], HH B, CMA D
7. MCP F
a. Paul Outreach/Enrollment Code: E, Begin Date: 4/1/14, End Date:8/31/15, HH B, CMA C
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b. Paul Outreach/Enrollment Code: E, Begin Date: 9/1/14, End Date: [blank], HH B, CMA D
Medicaid Eligibility End Date: Some Medicaid eligible members have indefinite Medicaid eligibility, meaning that
their Medicaid eligibility never expires. Within the Medicaid system, these members are listed with a Medicaid
eligibility end date of 12/31/9999. The MAPP HHTS does not use 12/31/9999 to indicate that a member is
indefinitely Medicaid eligible. This means that any member listed in Medicaid with an end date of 12/31/9999 will
be listed in the MAPP HHTS without a value in Medicaid Eligibility End Date (field #29).
8. Child HCBS Flag Based on R/E Code(field #34) This value will be populated based on RE codes K1 relating to
Children’s HCBS waiver codes. If the member has an active K1 RE code within the system as of the file download
that corresponds to children’s HCBS, the field will be populated with a ‘Y’, otherwise it will be set to ‘N’.
9. Transfer Information (field #35-42) will be populated for providers’ currently enrolled active or pending active
members that also have a pending transfer record.
a. HH A requests that HH B transfers a member to them. The member is currently in an active segment
with HH B. When HH A downloads their enrollment file they will not see any information about the
member. When HH B downloads the enrollment file, fields 35 – 42 will be populated on the
member’s active enrollment record with the member’s pending transfer information.
b. HH B then accepts the pending transfer. When HH B downloads the enrollment file again, HH B will
see the closed enrollment segment, but no transfer information (fields 35-42 will be blank).
c. Please refer to the transfer guide found under the Health Home Tracking System tab of the MAPP
HHTS portion of the HH website found at:
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/mapp/index.htm for
more specific information.
Members Download File
Description
This file is downloaded from the My Members screen, which displays members that have an outreach/enrollment
segment in any status, except for canceled, with the user’s provider in addition to members that have an active,
pending, or pended assignment with the user’s provider.
To download this file, a user must navigate to the My Members screen in the system, use the filters on that page
to identify the population that the user is interested in, and then select the Download Search Results button. This
will prompt the system to create a file matching the file format below containing the member segments and
assignment information that meet the criteria selected by the user. MCPs, HHs and CMAs can download this file.
Format
My Members Download File
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Member ID 1 8 8 Y AA11111A, Alphanumeric
2 First Name 9 30 38 Y Alpha
3 Last Name 39 30 68 Y Alpha
4 Date of Birth 69 8 76 Y MMDDYYYY, Numeric
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My Members Download File
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
5 MCP MMIS Provider ID 77 8 84 C Numeric
6 MCP Name 85 40 124 C Alphanumeric
7 HH MMIS Provider ID 125 8 132 C Numeric
8 HH Name 133 40 172 C Alphanumeric
9 CMA MMIS Provider ID 173 8 180 C Numeric
10 CMA Name 181 40 220 C Alphanumeric
11 Assignment Source 221 20 240 Y Alpha (DOH Identified, MCP Identified, Referral)
12 Assignment Created Date 241 8 248 C MMDDYYYY, Numeric
13 Pending Referral 249 1 249 C Alpha (Y/N)
14 Referral HH MMIS Provider ID 250 8 257 C Numeric
15 Referral HH Name 258 40 297 C Alphanumeric
16 Segment Type 298 1 298 Y Alpha (Assignment or Referral O or E)
17 Segment Status 299 20 318 Y Alpha (Pending, Pended, Active, Pending Active, Pending Pended, Pending Closed, Closed, Pending Canceled, or Hiatus)
18 Begin Date 319 8 326 C MMDDYYYY, Numeric
19 End Date 327 8 334 C MMDDYYYY, Numeric
20 End Date Reason 335 60 394 C Alphanumeric
21 Consent Date 395 8 402 C MMDDYYYY, Numeric
22 Pend Reason Code Description 403 40 442 C Alphanumeric
23 HARP 443 2 444 Y Alpha (Blank, EL, or EN)
24 Pioneer ACO 445 1 445 Y Alpha (Y/N)
25 Impacted Adult Home Member 446 1 446 Y Alpha (Y/N)
26 Address 1 447 40 486 Y Alphanumeric
27 Address 2 487 40 526 C Alphanumeric
28 City 527 40 566 Y Alpha
29 State 567 2 568 Y Alpha
30 Zip 569 9 577 Y Numeric
31 Phone 578 10 587 Y Numeric
32 County of Fiscal Responsibility Code 588 2 589 Y Numeric
33 County of Fiscal Responsibility Description
590 30 619 Y Alpha
34 Language 620 40 659 C Alpha
35 Gender 660 1 660 Y Alpha (M/F)
36 Medicaid Eligibility End Date 661 8 668 C MMDDYYYY, Numeric
37 DOH Composite Score 669 6 674 C Decimal, 999V99
38 Acuity Score 675 7 681 C Decimal, 99V999
39 Date of Patient Acuity 682 8 689 C MMDDYYYY, Numeric
40 Downloading Provider Assignment Created Date
690 8 697 C MMDDYYYY, Numeric
41 DOH Recommended HH 698 8 705 C Numeric
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My Members Download File
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
42 Rejected Assignment Suggested Alt Assignment
706 8 713 C Numeric
43 Member Age 714 3 716 Y Numeric
44 Assignment Start Date 717 8 724 C MMDDYYYY, Numeric
45 Downloading Provider Assignment Start Date
725 8 732 C MMDDYYYY, Numeric
46 Downloading Provider Assignment Status
733 40 772 C Alpha (Pending, Pended, Active)
47 Referral Suggested Assignment 773 8 780 C Numeric
Editing Logic
Since this file download may contain both segment and assignment information, based on the selection criteria on
the My Members screen prior to file download, some of the fields above may or may not be populated based on
the record source containing either segment information or assignment information. The table below describes
how each field will be populated based on the record source (segment or assignment).
Medicaid Eligibility End Date: Some Medicaid eligible members have indefinite Medicaid eligibility, meaning that
their Medicaid eligibility never expires. Within the Medicaid system, these members are listed with a Medicaid
eligibility end date of 12/31/9999. The MAPP HHTS does not use 12/31/9999 to indicate that a member is
indefinitely Medicaid eligible. This means that any member listed in Medicaid with an end date of 12/31/9999 will
be listed in the MAPP HHTS without a value in Medicaid Eligibility End Date (field #36).
My Members Fields Segment Record Assignment Record
Member ID Will always be populated
First Name Will always be populated
Last Name Will always be populated
Date of Birth Will always be populated
MCP MMIS Provider ID • For Managed Care members, these fields will be populated with the MCP that the member is enrolled with as of the file download.
• For fee for service members, these fields will be blank. MCP Name
HH MMIS Provider ID • If a member has an HH assignment with record type = assignment or a
segment with a corresponding HH assignment with record type = assignment that health home name and ID will be populated here.
• If a member does not have an HH assignment with record type = assignment these fields will be blank. *
HH Name
CMA MMIS Provider ID CMA listed on segment; for a segment record, these fields will always be populated.
CMA that member is assigned to; if member is not assigned to a CMA, then these fields will be blank. CMA Name
Assignment Source Will always be populated with the source of the member's assignment
Assignment Created Date Will always be blank Will be populated with the date of the member’s most recent assignment, based on the rules below**
Pending Referral Will always be blank Will always be populated
Referral HH MMIS Provider ID • If a member has an HH assignment with record type = referral or a segment with a corresponding HH assignment with record type = referral, that health home name and ID will be populated here. Referral HH Name
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My Members Fields Segment Record Assignment Record
• If a member does not have an HH with record type = referral, these fields will be blank. *
Segment Type Will always be populated Will always be blank
Segment Status Will always be populated Will always be blank
Begin Date Will always be populated Will always be blank
End Date Will be populated if the segment has an
end date Will always be blank
End Date Reason Will be populated if the segment is
closed Will always be blank
Consent Date Will only be populated if consent date has been submitted for the member
Will always be blank
Pend Reason Code Description Will only be populated if the segment is
pended Will always be blank
HARP Will always be populated with either EL, EN, or Blank
Pioneer ACO Will always be populated
Impacted Adult Home Member Will always be populated
Address 1 Will always be populated
Address 2 Will always be populated if the member has this field in the system
City Will always be populated
State Will always be populated
Zip Will always be populated
Phone Will always be populated if the member has this field in the system
County of Fiscal Responsibility Code Will always be populated
County of Fiscal Responsibility Description Will always be populated
Language Will be populated if language information has been submitted into the member's evidence either by a user online or through the MCP Final HH Assignment file upload.
Gender Will always be populated
Medicaid Eligibility End Date Will always be populated if the member has a Medicaid Eligibility End Date
otherwise this will be blank
DOH Composite Score Will be populated if available
Acuity Score Will be populated if available
Date of Patient Acuity Will be populated if available
Downloading Provider Assignment Created Date
Will always be blank Will be populated with the member’s
assignment created date with the downloading provider
DOH Recommended HH Will always be blank
Will only be populated when MCP downloads the file. When HH or CMA
downloads the file, this field will be blank
Rejected Assignment Suggested Alt Assignment
Will always be blank
Will be populated when a downstream provider suggests an
alternative assignment while rejecting an assignment. This field will always be blank when a CMA downloads this
file
Member Age Will be calculated based on the number of years from the Date of Birth to Today’s Date.
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My Members Fields Segment Record Assignment Record
Assignment Start Date Will always be blank
Will be populated with the start date of the member’s most recent active or pended reportable assignment.
***
This field will be blank if the assignment is pending. Populated
August 1, 2017
Downloading Provider Assignment Start Date
Will always be blank
Will be populated with the start date of the downloading organization’s most recent reportable assignment
record if the user’s provider’s assignment is in the active or pended
status. If the user’s provider’s assignment is not in the active or
pended status, then this field will be blank. Populated August 1, 2017
Downloading Provider Assignment Status Will always be blank
Will be populated with the status of the downloading organization’s most recent reportable assignment record.
Populated August 1, 2017
Referral Suggested Assignment Will always be blank
Will be populated with the provider listed in the Suggested Alt Assignment
field if the member has a Pending, Pended, or Active MCP assignment
record with record type referral.
*For all members, only two of the four fields are populated, depending on the record type of the HH assignment. If
the member has both an assignment and a referral, there will be two rows for the member in the download – one
row populating the assignment related fields and the other row populated the referral related fields. Regardless of
the user downloading the file, these fields are populated based on the data conditions described.
**The logic below determines the most recent assignment that will populate Assignment Created Date (field #12):
1. Does the member have a pending or active CMA assignment? a. Yes – CMA assignment created date displayed b. No – see #2
2. Does the member have a pending or active HH assignment? a. Yes – HH assignment created date displayed b. No – see #3
3. Does the member have a pending or active MCP assignment? a. Yes – MCP assignment created date displayed b. No – field should be blank
***Please use the logic below to determine the most recent assignment that will populate the Assignment Start Date (field #44):
4. Does the member have a reportable active CMA assignment?
a. Yes – CMA assignment start date displayed
b. No – see #2
5. Does the member have a reportable active HH assignment?
a. Yes – HH assignment start date displayed
b. No – see #3
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6. Does the member have a reportable active MCP assignment and no segment?
a. Yes – MCP assignment start date displayed
b. No – see #4
7. Does the member have a reportable pended MCP assignment?
a. Yes – MCP assignment start date displayed
b. No – field should be blank
Manage Assignments Download File
Description
This file is downloaded by a user from the online Manage Assignments screen, which displays the members that
have a pended or pending assignment/referral with the user’s organization. To download this file, a user must
navigate to the Manage Assignments screen in the system, use the filters on that page to identify the population
that the user is interested in, and then select the Download Search Results button. This will prompt the system to
create a file matching the file format below containing the member assignments that meet the criteria selected by
the user.
Format
Manage Assignments Download File
Field # Field Start Pos. Length
End Pos.
Required (Y/N/C-conditional) Format
1 Member ID 1 8 8 Y AA11111A, Alphanumeric
2 Member First Name 9 30 38 Y Alpha
3 Member Last Name 39 30 68 Y Alpha
4 Record Type 69 10 78 Y Alpha (Assignment, Referral, Transfer)
5 Status 79 7 85 Y Alpha (Pending, Pended)
6 Created By 86 40 125 Y Alpha
7 Source 126 20 145 Y Alpha
8 Created Date 146 8 153 Y MMDDYYYY, Numeric
9 Transfer Effective Date 154 8 161 C MMDDYYYY, Numeric
10 Actor 162 40 201 Y Alpha
11 Other 202 60 261 C Alpha
CIN Search Download File
Description
This file is downloaded by a user from the Member CIN Search screen, which is accessible by all users in the system
and allows a user to look up either an individual member or a group of members using a member’s CIN. To
download this file, a user must navigate to the Member CIN Search screen in the system, search for at least one-
member CIN and then select the Download Search Results button. This will prompt the system to create a file
matching the file format below containing information for the submitted member CINs.
Format
CIN Search Download File
Field # Field Start Pos. Length
End Pos.
Required (Y/N/C-
conditional) Format
1 Member ID 1 8 8 Y AA11111A, Alphanumeric
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CIN Search Download File
Field # Field Start Pos. Length
End Pos.
Required (Y/N/C-
conditional) Format
2 DOB 9 8 16 Y MMDDYYYY, Numeric
3 Gender 17 1 17 Y Alpha (M/F)
4 Medicaid Effective Date 18 8 25 C MMDDYYYY, Numeric
5 Medicaid Eligibility End Date 26 8 33 C MMDDYYYY, Numeric
6 Medicaid Coverage Code 34 2 35 C Numeric
7 Medicaid Coverage Description 36 40 75 C Alpha
8 MCP MMIS Provider ID 76 8 83 C Numeric
9 MCP Name 84 40 123 C Alphanumeric
10 MCP Enrollment Date 124 8 131 C MMDDYYYY, Numeric
11 MCP Assignment Status 132 40 171 C Alpha
12 Assigned HH MMIS Provider ID 172 8 179 C Numeric
13 Assigned HH Name 180 40 219 C Alphanumeric
14 Assigned HH Assignment Status 220 40 259 C Alpha
15 Enrolled HH MMIS Provider ID 260 8 267 C Numeric
16 Enrolled HH Name 268 40 307 C Alphanumeric
17 Assigned CMA MMIS Provider ID 308 8 315 C Numeric
18 Assigned CMA Name 316 40 355 C Alphanumeric
19 Assigned CMA Assignment Status 356 40 395 C Alpha
20 Enrolled CMA MMIS Provider ID 396 8 403 C Numeric
21 Enrolled CMA Name 404 40 443 C Alphanumeric
22 Segment Type 444 1 444 C Alpha (O/E)
23 Segment Status 445 40 484 C Alpha
24 Direct Biller Indicator 485 1 485 C Alpha (Y/N)
25 Begin Date 486 8 493 C MMDDYYYY, Numeric
26 End date 494 8 501 C MMDDYYYY, Numeric
27 Provider 1 Service Date 502 8 509 C MMDDYYYY, Numeric
28 Provider 1 Provider Name 510 40 549 C Alpha
29 Provider 1 Address 1 550 40 589 C Alphanumeric
30 Provider 1 Address 2 590 40 629 C Alphanumeric
31 Provider 1 City 630 40 669 C Alpha
32 Provider 1 State 670 2 671 C Alpha
33 Provider 1 Zip 672 9 680 C Numeric
34 Provider 1 Phone 681 10 690 C Numeric
35 Provider 2 Service Date 691 8 698 C MMDDYYYY, Numeric
36 Provider 2 Provider Name 699 40 738 C Alpha
37 Provider 2 Address 1 739 40 778 C Alphanumeric
38 Provider 2 Address 2 779 40 818 C Alphanumeric
39 Provider 2 City 819 40 858 C Alpha
40 Provider 2 State 859 2 860 C Alpha
41 Provider 2 Zip 861 9 869 C Numeric
42 Provider 2 Phone 870 10 879 C Numeric
43 Provider 3 Service Date 880 8 887 C MMDDYYYY, Numeric
44 Provider 3 Provider Name 888 40 927 C Alpha
45 Provider 3 Address 1 928 40 967 C Alphanumeric
46 Provider 3 Address 2 968 40 1007 C Alphanumeric
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CIN Search Download File
Field # Field Start Pos. Length
End Pos.
Required (Y/N/C-
conditional) Format
47 Provider 3 City 1008 40 1047 C Alpha
48 Provider 3 State 1048 2 1049 C Alpha
49 Provider 3 Zip 1050 9 1058 C Numeric
50 Provider 3 Phone 1059 10 1068 C Numeric
51 Provider 4 Service Date 1069 8 1076 C MMDDYYYY, Numeric
52 Provider 4 Provider Name 1077 40 1116 C Alpha
53 Provider 4 Address 1 1117 40 1156 C Alphanumeric
54 Provider 4 Address 2 1157 40 1196 C Alphanumeric
55 Provider 4 City 1197 40 1236 C Alpha
56 Provider 4 State 1237 2 1238 C Alpha
57 Provider 4 Zip 1239 9 1247 C Numeric
58 Provider 4 Phone 1248 10 1257 C Numeric
59 Provider 5 Service Date 1258 8 1265 C MMDDYYYY, Numeric
60 Provider 5 Provider Name 1266 40 1305 C Alpha
61 Provider 5 Address 1 1306 40 1345 C Alphanumeric
62 Provider 5 Address 2 1346 40 1385 C Alphanumeric
63 Provider 5 City 1386 40 1425 C Alpha
64 Provider 5 State 1426 2 1427 C Alpha
65 Provider 5 Zip 1428 9 1436 C Numeric
66 Provider 5 Phone 1437 10 1446 C Numeric
67 Recent Care Management Biller 1 Provider ID
1447 8 1454 C Numeric
68 Recent Care Management Biller 1 Provider Name
1455 40 1494 C Alpha
69 Recent Care Management Biller 1 Service Date
1495 8 1502 C MMDDYYYY, Numeric
70 Recent Care Management Biller 2 Provider ID
1503 8 1510 C Numeric
71 Recent Care Management Biller 2 Provider Name
1511 40 1550 C Alpha
72 Recent Care Management Biller 2 Service Date
1551 8 1558 C MMDDYYYY, Numeric
73 Recent Care Management Biller 3 Provider ID
1559 8 1566 C Numeric
74 Recent Care Management Biller 3 Provider Name
1567 40 1606 C Alpha
75 Recent Care Management Biller 3 Service Date
1607 8 1614 C MMDDYYYY, Numeric
76 Recent Care Management Biller 4 Provider ID
1615 8 1622 C Numeric
77 Recent Care Management Biller 4 Provider Name
1623 40 1662 C Alpha
78 Recent Care Management Biller 4 Service Date
1663 8 1670 C MMDDYYYY, Numeric
79 Recent Care Management Biller 5 Provider ID
1671 8 1678 C Numeric
80 Recent Care Management Biller 5 Provider Name
1679 40 1718 C Alpha
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CIN Search Download File
Field # Field Start Pos. Length
End Pos.
Required (Y/N/C-
conditional) Format
81 Recent Care Management Biller 5 Service Date
1719 8 1726 C MMDDYYYY, Numeric
82 Recent Care Management Biller 6 Provider ID
1727 8 1734 C Numeric
83 Recent Care Management Biller 6 Provider Name
1735 40 1774 C Alpha
84 Recent Care Management Biller 6 Service Date
1775 8 1782 C MMDDYYYY, Numeric
85 Medicaid Recipient Exemption Code 1 1783 2 1784 C Numeric
86 Medicaid Recipient Exemption Description 1
1785 40 1824 C Alpha
87 Medicaid Recipient Exemption Code 2 1825 2 1826 C Numeric
88 Medicaid Recipient Exemption Description 2
1827 40 1866 C Alpha
89 Medicaid Recipient Exemption Code 3 1867 2 1868 C Numeric
90 Medicaid Recipient Exemption Description 3
1869 40 1908 C Alpha
91 Medicaid Recipient Exemption Code 4 1909 2 1910 C Numeric
92 Medicaid Recipient Exemption Description 4
1911 40 1950 C Alpha
93 Medicaid Recipient Exemption Code 5 1951 2 1952 C Numeric
94 Medicaid Recipient Exemption Description 5
1953 40 1992 C Alpha
95 Error Field 1993 40 2032 C Alpha
96 Member Age 2033 3 2035 Y Numeric
97 First Name 2036 30 2065 Y Alpha
98 Last Name 2066 30 2095 Y Alpha
99 Program Participation 2096 7 2102 C Alpha
100 Opt-Out Signature Date 2103 8 2110 C MMDDYYYY, Numeric
101 Opt-Out Submission Date 2111 8 2118 C MMDDYYYY, Numeric
102 Opt-Out Submitted by User 2119 40 2158 C Alpha
103 Opt-Out Submitted by Organization Name
2159 40 2198 C Alpha
104 Pending Transfer Initiator MMIS ID 2199 8 2206 C Numeric
105 Pending Transfer Initiator Organization Name
2207 40 2246 C Alpha
106 Pending Transfer Receiver MMIS ID 2247 8 2254 C Numeric
107 Pending Transfer Receiver Organization Name
2255 40 2294 C Alpha
108 Pending Transfer Create Date 2295 8 2302 C MMDDYYYY, Numeric
109 Pending Transfer Effective Date 2303 8 2310 C MMDDYYYY, Numeric
110 Pending Transfer Reason 2311 75 2385 C Alpha
111 Pending Transfer Comment 2386 300 2685 C Alphanumeric
112 Medicaid Recipient Exemption Code 6 to 16
2686 32 2717 C Alphanumeric (space deliminated)
113 ACT Member 2718 1 2718 C Alpha (Y/N)
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Editing Logic
1. Medicaid Recipient Exemption Code Fields (field #s 84 – 94) The fields show a member’s recipient
exemption codes and descriptions for the first 5 most recent active RE codes based on the RE code’s begin
date. An active (RE code is defined as an RE code that either has no end date or has end date is in the
future.) associated with a member CIN will display in fields 85-94.
2. Medicaid Recipient Exemption Code 6 to 16 (field # 112): This field contains Aany additional active RE
codes, up to 16, will display under Medicaid Recipient Exemption Code 6 to 16 (field #112). An active RE
code is defined as an RE code that either has no end date or has end date is in the future. Data in this
field will include RE code only and be space deliminated.
Assessment Download File
Description
This file can be downloaded by MCPs, HHs and CMAs. It contains the children’s HCBS assessment information and
CANs-NY assessment information for assessments that have been signed and finalized in UAS and processed by the
MAPP HHTS. MCPs can see Assessment information for any member associated with their plan at the time the
assessment was signed and finalized. HHs/CMAs can see any assessment information for a member that has an
enrollment segment that either covers the period of time of the assessment or the subsequent 12 months after
the assessment’s signed and finalized date.
Format
Assessment Download File
Field # Field
Start Pos Length
End Pos Format
1 Member ID 1 8 8 Alphanumeric
2 Member First Name 9 30 38 Alpha
3 Member Last Name 39 30 68 Alpha
4 Assessment Type 69 1 69 Alpha (HCBS/CANs)
5 Assessment Outcome 70 1 70 Alpha (C/N/H/M/L)
6 Finalized Date 71 8 78 MMDDYYYY, Numeric
7 Assessor Organization Name 79 40 118 Alpha
8 Assessor Organization MMIS ID 119 8 126 Numeric
9 HH Name 127 40 166 Alphanumeric
10 HH MMIS Provider ID 167 8 174 Numeric
11 Target Population 175 1 175 Numeric (0/1/2/3)
Editing Logic
1) Member’s identifiable information (#1-3)
a) Member ID (field #1) is populated based on the data that is submitted in the person record in UAS
b) The system uses the data populated in Member ID (field #1) to pull Member First Name (field #2) and
Member Last Name (field # 3) from MDW
2) Fields displaying Assessment information (#4-8, 11)
a) Assessment Outcome (field #5) displays the outcome of the Assessment
i) For HCBS this includes either ‘C’ for LOC or ‘N’ for Not LOC
ii) For CANs this includes ‘H’, ‘M’ or ‘L’ to indicate the acuity level
Formatted: Font: 10 pt, Bold
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Formatted: Font: Bold
Formatted: List Paragraph, Numbered + Level: 1 +Numbering Style: 1, 2, 3, … + Start at: 1 + Alignment: Left +Aligned at: 0.25" + Indent at: 0.5"
Formatted: Font: Not Bold
Formatted: Font: 10 pt
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b) Target Population (field #11) is only populated for HCBS assessment records. This is populated based on
data submitted in UAS as follows:
i) 0 – SED (Serious Emotional Disturbance)
ii) 1 – MF (Medically Fragile)
iii) 2 – DD-MF (Developmental Disability Medically Fragile)
iv) 3 – DD-FC (Developmental Disability Foster Care)
3) Fields Displaying HH Data (#9-10)
a) If the record is a CANs-NY Assessment the information displayed in these fields will come from the values
entered in UAS. If the record is a HCBS Assessment the information displayed comes from MAPP HHTS data
as of the time the assessment was processed.
Billing Support The Billing Support functionality within the system enables CMAs, HHs, and MCPs to exchange billing information
regarding ALL Health Home members, including Managed Care and Fee for Service members.
PLEASE NOTE THAT THE MAPP HHTS BILLING SUPPORT ONLY FACILITATES THE EXCHANGE OF HEALTH HOME
BILLING INFORMATION. BILLING SUPPORT DOES NOT SUBMIT A HEALTH HOME CLAIM TO NYS MEDICAID.
Billing instances are either potential, added, or voided. Potential billing instances are created by the system for all
current and previous member months when a member is in a segment and a billable service could be performed.
For example, if a member is in an active enrollment segment but loses Medicaid eligibility a potential billing
instance will not display on the download file for the dates of service that co-inside with the time period in which
the member does not have Medicaid eligibility. Billing instances are not created for future service dates.
For example, if a user downloads a Billing Support Download (BSD) file on July 31, 2016, the user will see billing
instances for their members that meet the billing instance criteria through July 1, 2016. The user will not see
billing instances for service dates after July 1, 2016, even for members that meet the billing instance criteria and do
not have a segment end date. When the user downloads a BSD on August 1, 2016, the user will see billing
instances for members that meet the billing instance criteria through August 1, 2016.
MCP capitated billing
Reimbursement for Health Home services is included in Mainstream MCP (HMO, PHSP, SNP, HARP) capitation
rates. HHs bill eMEDny directly for FFS and non-mainstream MCP members but submit 837is for mainstream MCP
members to the member’s enrolled MCP as of the service date for payment.
Full and Limited HML billing
HML assessment questions are only required to be fully answered on a six-month basis. Once an HML is completed
for month one, the member’s HML responses are locked in for six months. During months two-six providers only
need to respond to certain questions: attesting if services were provided (e.g. Core Service, HH+ Minimum Services
Provided), member population questions (AOT, ACT, AH, Exp HH+ , the Chronic Condition/Pre-Condition question
(Chronic Condition question required for DOS on or after 12/1/19). If there are significant changes to a member’s
level of Care Management need, a new HML should be completed prior to month seven. This will act as a new
month one. An indicator on the download file informs the provider which month the completed HML represents.
Responses to unrequired questions from month 1 will be brought forward and displayed in month 2-6 on the
Billing Support Download file (effective 11/22/19).
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Should the provider respond to the HML outside of chronological order, the system will not be able to calculate the
month sequence and all questions must be answered. For example, a provider responds to all HML questions
(fields #7-18, #20-34) on May 1st, 2018, this HML is now considered month 1. The provider then goes to complete
the billing instance of July 1st, 2018 prior to completing the June 1st, 2018 billing instance. The provider will be
required to answer all HML questions (fields #7-18, #20-34) for the July billing instance.
Should a provider void a previously submitted billing instance, all future completed HMLs within the six-month
sequence will also be voided by the system. For example, today is 6/15/2018, a provider has already completed
the 5/1/18 BI (month 1), and the 6/1/18 BI (month 2) if the provider now voids the 5/1/18 BI, the system will
automatically delete the 6/1/18 BI as well.
Should an enrollment segment be ended for any reason and a new enrollment segment be created for the same
member with the same HH and CMA, the start of the new enrollment segment will be considered month one and
all HML questions will need to be submitted for that new enrollment segment. For example, HH A and CMA A have
an enrollment segment with Member A from 5/1/18 to 7/31/18. Under this segment 5/1/18 is month 1, 6/1/18 is
month 2, and 7/1/18 is month 3. On 8/1/18 HH A and CMA A create a new enrollment segment with member A
starting 8/1/18. When completing the 8/1/18 BI HH A must answer all HML questions and this will be considered
month 1.
Member’s served as children have Children’s Questionnaires that must be responded to in their entirety each
month.
Billing Support Upload File
Description
The purpose of the Billing Support Upload file is for a user to 1) indicate whether or not a billable service was
provided for a billing instance service date or to void a previously added billing instance submission, and 2) to
submit member information needed to support a Health Home claim for members that received a billable service.
For additional information on the logic that the system uses to calculate rates, please refer to the ‘Special
Population Logic & HML Logic Flow’ document located here:
https://health.ny.gov/health_care/medicaid/program/medicaid_health_homes/mapp/docs/special_population_a
nd_hml_logic_flow.pdf. If any question that is not required per the flow is answered, the system will ignore the
submitted value and display a blank field on the download.
The Billing Support Upload file is uploaded either by a CMA user or by a HH user on behalf of a CMA. A HH
submitting this file on behalf of a CMA does not have to indicate that the file is being submitted on behalf a CMA.
A HH submitting on behalf of numerous CMAs can either upload a separate file for each CMA or upload one file
containing billing information for members associated with different CMAs. An MCP cannot upload the Billing
Support Upload file; however, the data successfully processed into the system in this file are included in the Billing
Support Download file, which MCP, HH, and CMA users can download from the system.
Beginning with dates of service on or after April 1, 2016, organizations MUST ATTEST THAT A BILLABLE SERVICE
OCCURRED FOR A BILLING INSTANCE SERVICE DATE BY ADDING A MEMBER’S BILLING INSTANCE AND
CONFIRMING THAT A BILLABLE SERVICE OCCURRED WITHIN BILLING SUPPORT PRIOR TO THE APPROPRIATE
BILLER SUBMITTING THAT MEMBER’S MONTHLY HEALTH HOME CLAIM. Although there is no edit in eMedNY
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that denies Health Home claims that are not correctly documented within Billing Support, DOH will compare
submitted Health Home claims to Billing Support to identify providers that inappropriately submit Health Home
claims. These identified providers will have to either correct information submitted to the system or must void the
inappropriately submitted claims.
Format
Billing Support Upload File
Field # Field Start Pos Length
End Pos Format
1 Add/Void Indicator 1 1 1 Alpha (A/V)
2 Member ID 2 8 9 AA11111A, Alphanumeric
3 Service Date 10 8 17 MMDDYYYY, Numeric
4 Diagnosis Code 18 10 27 Alphanumeric
5 Health Home Qualifying Conditions 28 16 43 Numeric (no commas)
6 Description of "Other" Health Home Qualifying Conditions
44 40 83 Alphanumeric
7 HIV Status 84 1 84 Alpha (Y/N)
8 HIV Viral Load 85 1 85 Numeric
9 HIV T-Cell Count 86 1 86 Numeric
10 Member Housing Status 87 1 87 Alpha (Y/N)
11 HUD Category 88 1 88 Numeric
12 Incarceration 89 1 89 Alpha (Y/N/U)
13 Incarceration Release Date 90 8 97 MMDDYYYY, Numeric
14 Mental Illness or Physical Health Inpatient Stay
98 1 98 Alpha (Y/N/U)
15 Mental Illness or Physical Health Inpatient Discharge Date
99 8 106 MMDDYYYY, Numeric
16 Substance Abuse Inpatient Stay 107 1 107 Alpha (Y/N/U)
17 Substance Abuse Inpatient Stay Discharge Date
108 8 115 MMDDYYYY, Numeric
18 SUD Active Use/Functional Impairment
116 1 116 Alpha (Y/N)
19 Core Service Provided 117 1 117 Alpha (Y/N)
20 AOT Member 118 1 118 Alpha (Y/N)
21 AOT Minimum Services Provided 119 1 119 Alpha (Y/N)
22 ACT Member 120 1 120 Alpha (Y/N)
23 ACT Minimum Services Provided 121 1 121 Alpha (Y/N)
24 AH Member qualifies for Adult Home Plus Care Management
122 1 122 Alpha (Y/N)
25 AH Member transitioned to community
123 1 123 Alpha (Y/N)
26 AH Member continues to qualify 124 1 124 Alpha (Y/N)
27 AH Member interested in transitioning
125 1 125 Alpha (Y/N)
28 CMA Direct Biller Indicator 126 1 126 Alpha (Y/N)
29 Child in Foster Care 127 1 127 Alpha (Y/N)
30 HUD1 within past 6 months 128 1 128 Alpha (Y/N)
31 Member Housed 129 1 129 Alpha (Y/N)
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Billing Support Upload File
Field # Field Start Pos Length
End Pos Format
32 Date Member Housed 130 8 137 MMDDYYYY, Numeric
33 Expanded HH+ population 138 1 138 Alpha (A-X)
34 HH+ Minimum Services Provided 139 1 139 Alpha (Y/N)
35 UAS Complexity Assessment 140 1 140 Alpha (Y/N/U)
• Please see appendix H for appropriate responses based on date of service.
Editing Logic
1. Please see field descriptions in Appendix A: Field Descriptions for field descriptions, accepted field values,
and additional information on conditionally required Billing Support Upload file fields. Please see
Appendix H: High, Medium, Low (HML) Assessment Codes for the codes used on the Billing Support
Upload file.
2. Editing Logic for Enrollment Children’s Questionnaire, HML Questionnaire and Outreach Questions can be
found on the HH Website in the 2019 Quality Webinar – Billing Support files starting on slide 21:
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/mapp/docs/mapp_
hhts_webseries_billing_support_files.pdf
3. Add/Void Indicator (field #1)
a. To indicate that a billable service was provided for a billing instance submit a record with a value
of ‘A’ in Add/Void Indicator (field #1) and a value of ‘Y’ in Core Service Provided (field #19).
Complete all other required and conditionally required fields.
b. To indicate that a billable service was NOT provided for a billing instance submit a record with a
value of ‘A’ in Add/Void Indicator (field #1) and a value of ‘N’ in Core Service Provided (field
#19).
c. To indicate that a record previously submitted with a value of ‘A’ in Add/Void Indicator (field #1)
was submitted in error and should be voided, a record must be submitted containing an
Add/Void Indicator (field #1) value of ‘V’ and Member ID (field #2) & Service Date (field #3) must
match the values submitted in the original billing instance record that is being voided. The
system will ignore fields #4-35 on the Billing Support Upload file (i.e. the system will not validate,
or record values submitted in these fields) when the Add/Void Indicator contains a value of ‘V’.
d. Voiding an adult enrollment segment that was part of the six-month sequence will also void any
subsequent billing instances in that six-month period that were already completed.
e. The system will reject a record containing an Add/Void Indicator (field #1) value of ‘A’ submitted
for a member and Service Date (field #3) with a current Add/Void Indicator (field #1) value of
‘A’.
f. The system will reject a record containing an Add/Void Indicator (field #1) value of ‘V’ for a
member and Service Date (field #3) for which no add indicator was previously submitted or the
current value is ‘V’.
4. Attesting to Core Service (field #19) for Children
a. If the user uploads a file with a record for an enrollment segment where the CANS NY
Assessment result is Low or no CANS NY Assessment exists, populate Core Service Provided (field
#19) with a value of ‘Y’ if at least one core Health Home service was provided during the service
month.
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b. If the user uploads a file with a record for an enrollment segment where the CANS NY
Assessment result is Medium or High, populate Core Service Provided (field #19) with a value of
‘Y’ if at least two Health Home services were provided, one of which must be a face-to-face
encounter with the child.
5. Required fields for outreach
a. When submitting a record for a billing instance that is associated with an outreach segment and
the uploading provider is a Health Home that serves adults, serves both Adults and Children with
members over 21, or is a CMA that is working with one of these Health Homes , the following
fields are the only fields that are required to for adult records:
i. Add/Void Indicator (field #1)
ii. Member ID (field #2)
iii. Service Date (field #3)
iv. Diagnosis Code (field #4) (optional)
v. Core Service Provided (field #19)
vi. ACT Member (if Provider is Care Management Agency – ACT) (field #20)
b. If a user uploads a file for a member that has an outreach segment with a value of ‘C’ in Adult or
Child Services Provided Indicator (field #11) on their corresponding Outreach Segment, the
following fields are required and the system will ignore all other fields:
i. Add/Void Indicator (field #1)
ii. Member ID (field #2)
iii. Service Date (field #3)
iv. Diagnosis Code (field #4) (optional)
v. Core Service Provided (field #19)
vi. Child in Foster Care (field #29)
vii. ACT member (field #22) (only required if the CMA is identified as an ACT provider within
the MAPP HHTS)
viii. AOT member (field #20)
6. Required fields for a Children’s questionnaire:
a. If a user uploads a file for a member that has an enrollment segment with a value of ‘C’ in Adult
or Child Services Provided Indicator (field #11) on their corresponding Enrollment Segment, the
system will look to the following fields and will ignore all other fields:
i. Add/Void Indicator (field #1)
ii. Member ID (field #2)
iii. Service Date (field #3)
iv. Diagnosis Code (field #4) (optional)
v. Pre-Conditions of member (field #5)
vi. Core Service Provided (field #19)
vii. Child in Foster Care (field #29)
7. The system will reject a record that is submitted for a member for a specific date of service if it does not
meet certain requirements necessary to bill for Health Home services. In addition to the required field
combinations outlined in the power point referenced in #2 above, this includes:
a. The system will reject a record submitted for a member that does not have an active outreach or
enrollment segment with the uploading provider that would indicate that a billable service is
possible for that service date.
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i. Example – HH A is providing Health Home services to member B starting Feb 1st, but
submitted a segment for member B with a Jan 1st. When HH A attempts to upload a
completed HML for Jan 1st the system will reject it.
b. The system will reject a record submitted for a member whose status within MAPP HHTS
indicates that a billable service should not be provided for the member for the date of service,
even if the member is associated with the provider within the system as of the service date.
i. Example – A record submitted for a member with a pended enrollment with that
provider with a pend reason of incarceration will be rejected. Even though the member
is associated and enrolled with the submitting provider as of the billing instance service
date, the member does not have the appropriate segment status to qualify for a billing
instance on the service date.
ii. Example – Tim is in an active enrollment segment with HH B as of 12/1/18, but on
1/10/19 Tim receives R/E code 81 as he now qualifies for the TBI waiver. For dates of
service on or after 1/1/19 HH B is unable to upload a HML record for Tim.
1. In some instances, the Billing instance may be able to be completed online only
and not via file upload based on current HH policy. In most instances billing is
also prohibited on screen.
2. For example, member A is going to be released from a nursing home 5/15/18,
but the NH code has yet to be ended. Per DOH policy the member can receive
Health Home services for the month prior to and the month of discharge. The
system will allow the completion of the billing instance online, but not via file
upload.
c. The system will not accept an added enrollment billing instance for a member that is under 21, is
being served as a child and does not have a valid CANS on file for the service date. This includes:
i. Having no CANs-NY on file that corresponds to the 3rd month of an enrollment segment
ii. Having the latest CANs-NY on file that is more than 6 months old (including the month
the CANS NY Assessment was completed).
d. The system will reject a record submitted for a member with responses to the Adult Home (AH)
questions when the member is not in AH. If the member is not in AH, the following fields need to
blank:
i. AH Member qualifies for Adult Home Plus Care Management (field #24)
ii. AH Member transitioned to community (field #25)
iii. AH Member continues to qualify (field #26)
iv. AH Member interested in transitioning (field #27)
iv.e. The system will not require and ignore the Core Service Provided (Field #19) when the user has
responded ‘Y’ to AOT Minimum Services Provided (Field #21) or HH+ Minimum Services Provided
(Field #34).
8. Updates to CANS-NY Person Records made within the UAS are reflected in the MAPP HHTS. When a CIN is
added to the person record, all signed and finalized CANS-NY Assessments (that meet validations) are
transferred to the new CIN. The previous calculated acuity is used to determine billing. If a CANS-NY
Assessment Upon Enrollment is transferred, the Assessment Fee will only be tied to the original CIN,
however, any new CINs will utilize the calculated acuity for billing.
For example, Jane Doe is enrolled with HH A and CMA A starting on 12/1/17. Jane Doe’s initial CANS-NY
was completed on 12/16/17 and has a high acuity. On 3/10/18 Jane Doe is adopted. From 12/1/17 -
3/10/18 Jane Doe’s CIN is AA12345A. From 3/11/18-current Jane Doe’s CIN is BB12345B. Jane’s Care
manager is notified of Jane’s new CIN on 3/25/18. HHCM enters the UAS and updates the person record
Formatted: Font: Bold
Formatted
Formatted: Font: 10 pt
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to also include BB12345B. The care manager waits until the 1st of the following month to create a new
enrollment segment with the new CIN in MAPP HHTS. Jane Doe now has:
o A segment from 12/1/17-3/31/18 under CIN AA12345A
o A segment from 4/1/18 – open under CIN BB12345B
Within 15 minutes of creating the segment with CIN BB12345B, the high acuity from the initial CANs
appears under the CIN BB12345B and is used for BIs from 4/1/18 forward. Should the care manager still
need to complete the BI from 3/1/18 under AA12345A they will get the high acuity. When HH A
downloads the billing support download file they will see one Assessment Fee under CIN AA12345A.
9. Effective for service dates on or after 7/1/20, the Health Home program will no longer reimburse for
outreach services provided to Medicaid members. Providers can still create outreach segments for
members to indicate that the member is associated with that provider pre-enrollment, but providers will
no longer be able to bill for outreach services. As a result, the system will continue to create potential
billing instances for outreach segments within the system, but if a provider adds that potential outreach
billing instance into the system with a value of ‘Y’ in the Core Service Provided field, the billing instances
will not return rate value to indicate that outreach is no longer a billable service.
Billing Support Error File
Description
This file is created upon validating or processing a Billing Support Upload file containing at least one error. A Billing
Support Error file will not be created for a Billing Support Upload file that does not contain rejected records. The
Billing Support Error file will contain one record for each record in the Billing Support Upload file that contains an
error.
The Error Reason (field #2) will be populated with a description of why the record was rejected. The field will only
contain one error description. If a record hits more than one error, only the first error will be displayed in Error
Reason (field #2). This error file contains both file format errors and logic errors. For more information on Billing
Support errors, please review the Billing Support Upload: Editing Logic section and Appendix B: File Error Reason
Codes.
Error Files may be produced either when validating a file or when processing a file. Errors compare the values in
the upload file to what has already been written to the system (already processed), therefore it is possible to see
validation errors that would not result in processing errors.
Format
Billing Support Error File (.csv version of the Billing Support Error File includes BSU file upload fields in separate columns)
Field # Field
Start Pos Length
End Pos
Required (Y/N/C – conditional) Format
1 Original Record from File 1 140 140 Y Alphanumeric
2 Error Reason 141 40 181180 Y Alphanumeric
Formatted: Numbered + Level: 1 + Numbering Style: 1, 2,3, … + Start at: 1 + Alignment: Left + Aligned at: 0.25" +Indent at: 0.5"
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Billing Support Download File
Description
The purpose of the Billing Support Download file is to provide MCPs, HHs, and CMAs with monthly billing
information for members that they are associated with in the MAPP HHTS. This file contains a combination of
information that was submitted into the system by HHs and CMAs, supplied by NYS Medicaid, and generated by
the system based on information supplied by HHs/CMAs and NYS Medicaid. Included in the file format is a column
indicating the source of each field.
The Billing Support Download file contains a single record for each potential, added, and voided member billing
instance that is associated with the downloading provider, based on the criteria indicated when downloading the
file.
When downloading the BSD file, the user must indicate a maximum of a six-month period that the billing support
download should be downloaded for. Users have the option to either select a Date of Service range or a Last
Transaction Date range when downloading the file. When selecting the Date of Service range, the BSD will include
all known billing instances (potential, added and voided) for the date of services selected. For example, if a user
downloads the BSD with a date of service range from 12/1/16-5/31/17 on 6/1/17, the file will contain all billing
instances for 12/1/16, 1/1/17, 2/1/17, 3/1/17, 4/1/17, and 5/1/17 dates of service. If a member had a billing
instance added for a 12/1/16 date of service on 1/2/2017, this added billing instance will be included in the file. If
this member’s billing instance was later voided on 7/15/17, the voided billing instance would not be included on
the file downloaded on 6/1/17. A new file with the most recent six months of service downloaded on 8/1/2017
would not show this voided billing instance as the search perimeters would only be from 2/1/17-7/31/17.
When selecting the Last Transaction Date range, the file will display any billing instances within the last transaction
date range regardless of service date. The file will display all billing instances associated with a specific member’s
specific date of service that fall within the transaction date range. For example, if the same user downloaded the
BSD with a last transaction date range from 2/1/17-7/31/2017 on 8/1/17 the user would see the voided BI for the
member that was voided on 7/15/17, but not the added transaction from 1/2/2017. If the user had then gone in
on 7/20/17 and re-added the billing instances both the voided BI from 7/15/17 and the re-added 7/20/17 billing
instance would display.
As stated previously, there are three types of billing instances: potential, added, and voided. A potential billing
instance is a service date that has a corresponding segment during the same time period and has therefore been
created within the system as a billing instance, but has not yet been added to the system (user has not yet
submitted a record containing the billing instance service date with a value of ‘A’ in Add/Void Indicator (field #1).
An added billing instance is a service date that meets the billing instance criteria and has been added to the
system (appropriate user submitted a record containing the billing instance service date with a value of ‘A’ in
Add/Void Indicator (field #1). A voided billing instance is a service date that meets the billing instance criteria,
was previously added to the system (appropriate user submitted a record containing the billing instance service
date with a value of ‘A’ in Add/Void Indicator (field #1)), but has since been voided (appropriate user submitted a
record containing the billing instance service date with a value of ‘V’ in the Add/Void Indicator (field #1) for a
previously added billing instance with the same billing instance service date).
Potential billing instances are identified within the Billing Support Download file with a blank value in Add/Void
Indicator (field #1). Added billing instances are identified within the Billing Support Download file with a value of
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‘A’ in Add/Void Indicator (field #1). Voided billing instances are identified within the Billing Support Download file
with a value of ‘V’ in Add/Void Indicator (field #1).
All billing instances start in a potential status in the system. This means that the Billing Support Download file will
contain one record for each potential billing instance. Once a user submits an Add/Void Indicator (field #1) value
of ‘A’ for a potential billing instance, that potential billing instance record becomes an added billing instance record
in the download and the blank Add/Void Indicator (field #1) is updated to contain a value of ‘A’. Within the newly
downloaded Billing Support Download file, there is still only one record for that billing instance containing a value
of ‘A’ in the Add/Void Indicator (field #1). If that same billing instance is voided, then a NEW billing instance
record is added to the Billing Support Download file to indicate to users that the previously added billing instance,
and any claims submitted to eMedNY based on that added billing instance, need to be voided. This means that,
depending on how the provider downloads the file, the billing instance will have two records within the Billing
Support Download file: the original added billing instance and the voided billing instance. The submission of a
Billing Support Upload file with an Add/Void Indicator (field #1) value of ‘V’ does not delete the previously
uploaded record with an Add/Void Indicator (field #1) value of ‘A’, it only adds an additional record to the Billing
Support Download file showing that the previously added billing instance must be voided.
For example, in May 2016 Tina, a member of MCP A, is enrolled in the Health Home Program with HH B and CMA C
with a begin date of 5/1/16. On June 3, 2016, a user from MCP A downloads the Billing Support Download file
using the date of service range 5/1/16-6/30/16 and sees that Tina has two records within the file for service dates
5/1/16 and 6/1/16. Since neither of Tina’s records in the Billing Support Download file have a value in Add/Void
Indicator (field #1), MCP A user knows that these records represent Tina’s potential billing instances and that the
CMA has not yet added these billing instances to billing support. On June 10, 2016, a user from HH B submits a
Billing Support Upload file on behalf of CMA C with two records for Tina containing a value of ‘A’ in Add/Void
Indicator (field #1) and a value of ‘Y’ in Core Service Provided (field #19) for service dates 5/1/16 and 6/1/16. The
MCP user downloads the Billing Support Download file on June 12, 2016 using the date of service range 5/1/16-
6/30/16 and sees that there are still two records for Tina in the file. Since both of Tina’s records in the Billing
Support Download file now have a value of ‘A’ in Add/Void Indicator (field #1) a value of ‘Y’ in Core Service
Provided (field #19), MCP A user knows that these billing instances were added and that services were provided.
Therefore, the appropriate biller, in this case MCP A, submits claims to eMedNY (since this is prior to May 1st,
2018) for Tina for 5/1/16 and 6/1/16. On June 30, 2016, CMA C user realizes that Tina did not receive a billable
service in June and that the 6/1/16 billing instance needs to be voided, so CMA C submits a Billing Support Upload
file for Tina for service date 6/1/16 with a value of ‘V’ in Add/Void Indicator (field #1). On June 30, 2016, MCP A
downloads the Billing Support Download file using the date of service range 5/1/16-6/30/16 and now sees three
records for Tina:
1. service date 5/1/16; Add/Void Indicator ‘A’; Date HML Assessment Entered 6/10/16
2. service date 6/1/16; Add/Void Indicator ‘A’; Date HML Assessment Entered 6/10/16
3. service date 6/1/16; Add/Void Indicator ‘V’; Date HML Assessment Entered 6/30/16
This indicates to the MCP A user that the billing instance added for service date 6/1/16 on 6/10/16 was added in
error. Since MCP A already submitted to eMedNY a Health Home claim for Tina for 6/1/16, this indicates to the
MCP A that the 6/1/16 Health Home claim must be voided. Both the original added billing instance record and the
subsequent voided billing instance record are included in the download file and will remain in the download file so
that MCP A has a record to support why the original claim was submitted to eMedNY for Tina for 6/1/16 and
documentation to support why MCP A voided Tina’s 6/1/16 claim.
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Populating the Claims/Encounters Feedback Loop on the Billing Support Download File
Once a billing instance is added to the system indicating that a billable service was provided for a service date, the
system will start querying NYS Medicaid claim and encounter information to identify specific paid, denied, or
voided Health Home claims and paid or voided encounters (denied encounters are not reported to Medicaid) that
are associated with a member’s billing instance service date. Once a claim or encounter is submitted to eMedNY,
it takes about a week or so for the system to access and pull that claim or encounter information into billing
support.
While only one provider will be reimbursed for a member’s Health Home service for a specific month, it’s possible
that more than one denied claim exists in the NYS Medicaid claims system for a member’s billing instance service
date. As a result, the system uses the logic outlined below to determine what claim information should be
displayed within Billing Support.
1. Are there any paid claims or encounters in the system?
a. Yes:
i. The system will populate fields #57 - 66 based on the paid claim/encounter in the
system for the member’s billing instance service date.
ii. The system will compare the expected rate code (field #54) to the rate code on the paid
claim/encounter (Paid Claim Rate Code (field #66)). If the rate codes match, Paid Claim
Rate Code equals MAPP HML Rate Code (field #68) will be populated with a value of ‘Y’.
If the rate codes do not match, Paid Claim Rate Code equals MAPP HML Rate Code
(field #68) will be populated with a value of ‘N’.
iii. The system will compare the expected billing MMIS provider ID (Billing Entity MMIS ID
(field #20)) to the MMIS provider ID on the paid claim/encounter (Paid Claim Provider
ID (field #64)). If the MMIS provider IDs match, Paid Claim Provider ID equals MAPP
Billed Entity MMIS ID (field #67) will be populated with a value of ‘Y’. If the MMIS
provider IDs do not match, Paid Claim Provider ID equals MAPP Billed Entity MMIS ID
(field #67) will be populated with a value of ‘N’
b. No – see #2
2. Are there any denied claims or voided claims/encounters in the system?
a. Yes – see # 3
b. No – fields #57-68 will be blank
3. Display information related to the most recent transaction for the member’s billing instance service date.
a. The system will populate fields #57 - 66 based on the most recent denied/voided
claim/encounter.
b. The system will compare the expected rate code (Rate Code (field #54)) to the rate code on the
claim/encounter (Paid Claim Rate Code (field #66)). If the rate codes match, Paid Claim Rate
Code equals MAPP HML Rate Code (field #68) will be populated with a value of ‘Y’. If the rate
codes do not match, Paid Claim Rate Code equals MAPP HML Rate Code (field #68) will be
populated with a value of ‘N’.
c. The system will compare the expected billing MMIS provider ID (Billing Entity MMIS ID (field
#20)) to the MMIS provider ID on the denied claim/encounter (Paid Claim Provider ID (field
#64)). If the MMIS provider IDs match, Paid Claim Provider ID equals MAPP Billed Entity MMIS
ID (field #67) will be populated with a value of ‘Y’. If the MMIS provider IDs do not match, Paid
Claim Provider ID equals MAPP Billed Entity MMIS ID (field #67) will be populated with a value
of ‘N’.
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Format
Billing Support Download File
Field # Field
Start Pos Length
End Pos Req'd Source Format
1 Add/Void Indicator 1 1 1 Y HH/CMA Alpha (A/V/Null)
2 Member ID 2 8 9 Y HH/CMA AA111111A, Alphanumeric
3 Service Date 10 8 17 Y HH/CMA MMDDYYYY, Numeric
4 HH MMIS Provider ID
18 8 25 Y HH/CMA Numeric
5 Billing Instance Type
26 1 26 Y HH/CMA Alpha (O/E/F)
6 Member Fiscal County Code
27 2 28 Y M'caid Numeric
7 MCP MMIS Provider ID
29 8 36 C M'caid Numeric
8 Adjusted Acuity Score as of Service Date
37 7 43 C M'caid Null value (blank)
9 Diagnosis Code 44 10 53 N HH/CMA Alphanumeric
10 Medicaid Eligibility Status
54 1 54 Y M'caid Alpha (Y/N)
11 Pend Reason Code 55 2 56 C HH/CMA Alphanumeric
12 Pend Reason Code Description
57 40 96 C HH/CMA Alphanumeric
13 Member Fiscal County Code Description
97 40 136 Y M'caid Alphanumeric
14 Date Assessment Entered
137 8 144 C Gen MMDDYYYY, Numeric
15 CMA Name 145 40 184 Y M’caid Alphanumeric
16 CMA MMIS Provider ID
185 8 192 Y HH/CMA Numeric
17 Payor 193 1 193 Y HH/CMA Alpha (P/F/Blank)
18 HH Name 194 40 233 Y M’caid Alphanumeric
19 MCP Name 234 40 273 C M'caid Alphanumeric
20 Billing Entity MMIS ID
274 8 281 C Gen Numeric
21 Billing Entity Name 282 40 321 C Gen Alphanumeric
22 Member Zip Code 322 9 330 Y M'caid Numeric
23 Member First Name
331 30 360 Y M'caid Alpha
24 Member Last Name 361 30 390 Y M'caid Alpha
25 Member DOB 391 8 398 Y M'caid MMDDYYYY, Numeric
26 Member Gender 399 1 399 Y M'caid Alpha (M/F)
27 Base Acuity Score as of Service Date
400 7 406 C M'caid Null Value (blank)
28 HH Qualifying Conditions
407 16 422 C HH/CMA Numeric
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Billing Support Download File
Field # Field
Start Pos Length
End Pos Req'd Source Format
29 Description of "Other" Health Home Qualifying Conditions
423 40 462 C HH/CMA Alphanumeric
30 Risk 463 6 468 C M'caid Null Value (blank)
31 Current HARP Status
469 2 470 Y M'caid Alpha (Blank, EL, or EN)
32 HIV Status 471 1 471 Y HH/CMA Alpha (Y/N)
33 HIV Viral Load 472 1 472 C HH/CMA Numeric
34 HIV T-Cell Count 473 1 473 C HH/CMA Numeric
35 Member Living Status
474 1 474 Y HH/CMA Alpha (Y/N)
36 HUD Category 475 1 475 C HH/CMA Numeric
37 Incarceration 476 1 476 Y HH/CMA Alpha (Y/N)
38 Incarceration Release Date
477 8 484 C HH/CMA MMDDYYYY, Numeric
39 Mental Illness or Physical Health Inpatient Stay
485 1 485 Y HH/CMA *Alpha
40 Mental Illness or Physical Health Inpatient Discharge Date
486 8 493 C HH/CMA MMDDYYYY, Numeric
41 Substance Abuse Inpatient Stay
494 1 494 Y HH/CMA Alpha (Y/N)
42 Substance Abuse Inpatient Stay Discharge Date
495 8 502 C HH/CMA MMDDYYYY, Numeric
43 SUD Active Use/Functional Impairment
503 1 503 Y HH/CMA Alpha (Y/N)
44 Core Service Provided
504 1 504 Y HH/CMA Alpha (Y/N)
45 AOT Member 505 1 505 Y HH/CMA Alpha (Y/N)
46 AOT Minimum Services Provided
506 1 506 C HH/CMA Alpha (Y/N)
47 ACT Member 507 1 507 Y HH/CMA Alpha (Y/N)
48 ACT Minimum Services Provided
508 1 508 C HH/CMA Alpha (Y/N)
49 Impacted Adult Home Class Member
509 1 509 Y M'caid Alpha (Y/N)
50 AH Member qualifies for Adult Home Plus Care Management
510 1 510 C HH/CMA Alpha (Y/N)
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Billing Support Download File
Field # Field
Start Pos Length
End Pos Req'd Source Format
51 AH Member transitioned to community
511 1 511 C HH/CMA Alpha (Y/N)
52 AH Member continues to qualify
512 1 512 C HH/CMA Alpha (Y/N)
53 AH Member interested in transitioning
513 1 513 C HH/CMA Alpha (Y/N)
54 Rate Code 514 4 517 Y Gen Numeric
55 Rate Code Description
518 30 547 Y Gen Alphanumeric
56 Rate Amount 548 7 554 Y Gen Numeric, "0000.00"
57 Claim Status 555 1 555 C M'caid Alpha (P/D/Blank)
58 Date of Transaction 556 8 563 C M'caid MMDDYYYY, Numeric
59 Payment Cycle 564 4 567 C M'caid Numeric
60 Denial Reason Code 568 4 571 C M'caid Numeric
61 Denial Reason Code Description
572 25 596 C M'caid Alphanumeric
62 Denial Reason Code (2)
597 4 600 C M'caid Numeric
63 Denial Reason Code Description (2)
601 25 625 C M'caid Alphanumeric
64 Paid Claim Provider ID
626 8 633 C M'caid Numeric
65 Paid Claim Provider Name
634 40 673 C M'caid Alphanumeric
66 Paid Claim Rate Code
674 4 677 C M'caid Numeric
67 Paid Claim Provider ID equals MAPP Billed Entity MMIS ID
678 1 678 C Gen Alpha (Y/N)
68 Paid Claim Rate Code equals MAPP HML Rate Code
679 1 679 C Gen Alpha (Y/N)
69 Latest Transaction 680 1 680 Y Gen Alpha (Y/N)
70 Child in Foster Care 681 1 681 C HH/CMA Alpha (Y/N/Blank)
71 Last Transaction Date Time
682 16 697 Y Gen MMDDYYYYHH:MM:SS, Numeric
72 Insert Date 698 8 705 Y Gen MMDDYYYY, Numeric
73 CANS Completion Date
706 8 713 C M'caid MMDDYYYY, Numeric
74 Void Date 714 8 721 C Gen MMDDYYYY, Numeric
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Billing Support Download File
Field # Field
Start Pos Length
End Pos Req'd Source Format
75 HUD1 Within Past 6 Months
722 1 722 C Alpha (Y/N) Alpha (Y/N)
76 Member Housed 723 1 723 C Alpha (Y/N) Null Value (blank)
77 Date Member Housed
724 8 731 C MMDDYYYY, Numeric
MMDDYYYY, Numeric
78 Expanded HH+ population
732 1 732 C HH/CMA Alpha*
79 HH+ minimum services provided
733 1 733 C HH/CMA Alpha (Y/N)
80 Provided Service Indicator
734 1 734 Y HH/CMA Alpha (A/C)
81 UAS Complexity Assessment
735 1 735 Y HH/CMA Alpha (Y/N/U)
82 Encounter Claim 736 1 736 C Gen Alpha (C/E/Blank)
83 Month Submitted 737 1 737 R Gen Alphanumeric
84 MCP Type 738 10 747 Alpha
85 Validation Code 748 1 748 Alpha (A/B/C/D/E/F/G/H/I/J)
86 Validation Code Description
749 80 828 Alphanumeric
• Please refer to Appendix H for potential values of these fields based on the service dates
Editing Logic
1) Medicaid Eligibility Status (field #10) will display the member’s status as of the billing instance service date.
2) The Billing Support Download file only contains members that are associated with the downloading provider
as of the service date.
a) Example – Marco is an MCP A member January –February. Marco is enrolled in HH B in January and then
enrolled in HH D in February. MCP A will see billing instance service dates for January and February in the
Billing Support Download file. HH D will see billing instance service date 2/1/16 in the Billing Support
Download file. HH B can will see billing instance service date 1/1/16 in the Billing Support Download file.
3) Deleted Segments
a) If a potential billing instance’s corresponding segment is deleted, then the potential billing instance will no
longer exist within the system. There will be no record of the potential billing instance within the system or
on the downloaded file.
i) John enrolled beginning 7/1/16. The 7/1/16 billing instance was never added. In July, the billing
download file contains a record for John for a potential 7/1/16 billing instance with a blank in the A/V
field. In August, John’s 7/1/16 enrollment segment is deleted. The billing file downloaded in August
does not contain a 7/1/16 billing instance for John.
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b) If an added billing instance’s corresponding segment is deleted, then the added billing instance will remain
within the system and the system will automatically create a NEW voided billing instance for that
member/service date.
i) Miriam enrolled 7/1/16 and a billing instance was added in July. In July, the billing download file
contains a record for Miriam’s added 7/1/16 billing instance with an A in the A/V field. In August,
Miriam’s 7/1/16 enrollment segment is deleted. The billing file downloaded in August contains 2
records for Miriam:
(1) 7/1/16 billing instance with value of ‘A’ Add/Void Indicator field
(2) 7/1/16 billing instance with value of ‘V’ Add/Void Indicator field
c) If a voided billing instance’s corresponding segment is deleted, then the voided billing instance will remain
within the system.
i) Wayne enrolled 7/1/16 and a billing instance was added in July. In July, the billing download file
contains a record for Wayne’s added 7/1/16 billing instance. In August, Wayne’s 7/1/16 billing
instance is voided. The billing file downloaded in August contains both an added and a voided record
for Wayne’s 7/1/16 billing instance. In September, Wayne’s 7/1/16 enrollment segment is deleted. In
September, the billing download file contains 2 records for Wayne:
(1) 7/1/16 billing instance with value of ‘A’ Add/Void Indicator field
(2) 7/1/16 billing instance with value of ‘V’ Add/Void Indicator field
d) 3a-3c above only apply to billing instances with a value of ‘O’ or ‘E’ in Billing Instance Type (field #5). If the
billing instance has a value of ‘F’ in Billing Instance Type (field #5), then nothing will happen to the billing
instance when the segment is deleted.
4) The Pend Reason Code (field #11) and Pend Reason Code Description (field #12) will be blank for all billing
instances that are not in Pend status on the billing instance service date.
5) When a provider submits a month 2-6 HML responses, the system will populate the non-required fields on
BSD for month 2-6 BIs with the values submitted on the corresponding month 1 BI. Users can use Month
Submitted (field #83) to determine what month a service date is for a member. Children’s Questionnaires and
CANs-NY Assessment Fees will always be populated with a 1.
6) Conditionally Required Fields
a) The following conditional fields are populated with a value of ‘0’ if they were not required on the Billing
Support Upload file. If these non-required fields were populated on the Billing Support Upload by the
submitting provider in error, then the system will ignore the values submitted in these fields on the Billing
Support Upload file and these fields will populate these fields with a value of ‘0’ on the Billing Support
Download file.
i) HIV Viral Load (field #33)
ii) HIV T-Cell Count (field #34)
iii) HUD Category (field #36)
b) The following fields will be blank if they were not required on the Billing Support Upload file. If these non-
required fields were populated on the Billing Support Upload by the submitting provider, then the system
will ignore the values submitted in these fields on the Billing Support Upload file and these fields will be
blank on the Billing Support Download file.
i) Incarceration Release Date (field#38)
ii) Mental Illness or Physical Health InpatientDischarge Date (field #40)
iii) Substance Abuse Inpatient Stay Discharge Date (field #42)
iv) AOT Minimum Services Provided (field #46)
v) ACT Minimum Services Provided (field #48)
vi) AH Member qualifies for Adult Home Plus Care Management (field #50)
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vii) AH Member transitioned to community (field #51)
viii) AH Member continues to quality (field #52)
ix) AH Member interested in transitioning (field #53)
7) Latest Transaction (field #69)
a) Used to indicate which Billing Instance for a member’s service date is most recent, based on date and time
of the Adult HML/Children’s Questionnaire submission. Value of ‘Y’ means that the record is the most
recent record.
8) For members under 21 that are being served by children’s programs, the system will look to a data feed from
the CANS NY Assessment tool to determine if a CANS NY Assessment has been completed for a member. If
the information from that CANS NY Assessment feed passes the criteria below, then the system will create a
CANS NY Assessment Fee billing instance.
a) The CIN from the feed is valid and exists in the system.
b) The HH MMIS ID from the feed exists in the system as a valid Health Home.
c) An Enrollment Segment exists in an Active, Closed or Pended status for the CIN and HH MMIS ID on the
record with a begin date that is in the same month of the CANS Date of Completion or in the subsequent 6
months from the CANS Date of Completion.
d) The Assessment type selected when completing the CANS NY is ‘Initial Upon Enrollment’
e) The Assessment Fee has not been written to a previous record due to a member CIN change
9) Users cannot add or void a CANS NY Assessment Fee billing instance. Only the system can add or void a CANS
NY Assessment Fee billing instance.
10) Billing instances with a Billing Instance Type (field #5) value of ‘F’ will contain values in the following fields. All
other fields will be blank.
a) Add/Void Indicator (field #1)
b) Member ID (field #2)
c) Service Date (field #3)
d) HH MMIS ID (field #4)
e) Billing Instance Type (field #5)
f) Member Fiscal County Code (field #6)
g) MCP MMIS ID (field #7)
h) Medicaid Eligibility Status (field #10)
i) Member Fiscal County Code Description (field #13)
j) CMA Name (field #15)
k) CMA MMIS Provider ID (field #16)
l) HH Name (field #18)
m) MCP Name (field #19)
n) Billing Entity MMIS ID (field #20)
o) Billing Entity Name (field #21)
p) Member Zip Code (field #22)
q) Member First Name (field #23)
r) Member Last Name (field #24)
s) Member DOB (field #25)
t) Member Gender (field #26)
u) Rate Code (field #54)
v) Rate Code Description (field #55)
w) Rate Amount (field #56)
x) Claim Status (field #57)
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y) Date of Transaction (field #58)
z) Payment Cycle (field #59)
aa) Denial Reason Code (field #60)
bb) Denial Reason Code Description (field #61)
cc) Denial Reason Code (2) (field #62)
dd) Denial Reason Code Description (2) (field #63)
ee) Paid Claim Provider ID (field #64)
ff) Paid Claim Provider Name (field #65)
gg) Paid Claim Rate Code (field #66)
hh) Paid Claim Provider ID equals MAPP Billed Entity MMIS ID (field #67)
ii) Paid Claim Rate Code equals MAPP HML Rate Code (field #68)
jj) CANS Completion Date (field #73)
kk) Latest transaction (field #69)
ll) Last Transaction Date Time (field #71)
11) For billing instances with a Billing Instance Type (field #5) value of ‘O’ or ‘E’, the system will populate the
CANS Completion Date (field #73) with the signed and finalized date of the CANS NY Assessment that
determined the rate amount for the billing instance was completed.
12) The Payor (field #17): ‘P’ for members enrolled in a mainstream plan or ‘F’ for members enrolled in a non-
mainstream plan and fee for service members.
13) The file will first display all records with a value of ‘O’ and ‘E’ in Billing Instance Type (field #5) and will then
display all records with a value of ‘F’ in Billing Instance Type (field #5).
14) Last Transaction Date Time (field #71) is populated with the date and time that the record was last modified,
regardless of the billing instance status.
15) Insert Date (field #72) is always populated with the date that the billing instance was first created. If a
segment was created on 4/28/2017 at 11:07:23 AM with a begin date of 3/1/2017, then the system would
create a potential billing instance for that member for service date 3/1/2017 with an insert date of 4/28/17
and a last transaction date/time of ‘0428201711:07:23’. If that billing instance was then added on 4/29/2017
at 10:07:23 AM, then the system would create a new added billing instance with an insert date of 4/28/17 and
a last transaction date/time of ‘0429201710:07:23’. If that added billing instance was then voided on
4/29/2017 at 12:07:23 PM, then the system would create a new voided billing instance with an insert date of
4/28/17 and a last transaction date/time of ‘0429201712:07:23’.
16) Void Date (field #74) only displays for voided billing instances and will display the date the billing instance was
voided.
17) Provided Service Indicator (field #80) will be populated with an “A” for Adult or “C” for Child based on the
network type associated with the segment.
18) UAS Complexity Assessment (field #81) will be populated with a ‘Y’, ‘N’, or ‘U’.
19) Encounter Claim (field #82) will be populated with a ‘E’, ‘C’, or be blank. This field indicates the type of
payment (claim: FFS through Medicaid or encounter: paid for by plan) reported to Medicaid for the member
for the given date of service and corresponds to the claims feedback loop data contained in fields 57-68.
20) MCP Type (field #84) will be populated with HMO, PHSP, SNP, HARP, FIDA, MLTC, MAP, OTHER, OR BLANK
21) Validation Code (field #85) and Validation Code Description (field #86):
a) Validation codes appear on the Billing Support Download file when a potential billing instance would be
prevented from being added to the system (see Appendix P: Billing Instance Validation Codes for codes,
validations, validation ordering), meaning that the member is not eligible for Health Home services that
month. For example, if a member is not Medicaid eligible as of the BI service date the system will create a
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BI for that month with a value of ‘E’ in the Validation Code field and a value of ‘Cannot create assessment
for Medicaid Ineligible members’ in the Validation Code Description field.
b) If a potential billing instance fails more than one validation the system will populate the first validation
detected based on the processing order of operations outlined in Appendix P: Billing Instance Validation
Codes. For example, if the member is Medicaid ineligible and does not have a valid Plan of Care, the
validation code associated with that BI would be ‘E’ and not ‘J’.
Provider Files
Partner Network File Upload
Description
This file is uploaded into the system by HHs only. MCPs and CMAs cannot upload this file into the system. The HHs
use this file to submit to the system their network of providers. While this file must include the CMAs that a HH is
working with, it must also include the HHs network of providers that have agreed to work with the HH to
coordinate all of a member’s needs. This information uploaded in this file serves three purposes:
1. DOH first reviewed this list during the initial Health Home application review to determine if provider had
an adequate network to be designated as a Health Home. DOH continues to monitor this list to ensure
that all designated HHs maintain a diverse and robust network of providers that are available to work with
Health Home members.
2. DOH uses this network list to create adult member’s Health Home assignments by comparing the NPIs
listed in this file to a member’s claim and encounter information to determine which HH has the best
connection to the providers that the member has an existing relationship with.
3. These lists are posted to the Health Home website for community members to use when assisting a
community referral in picking a Health Home.
This is a full file replacement, meaning that every time this file is uploaded it must include all providers that are
currently working with the HH. This file must be uploaded every time a provider relationship with the HH either
begins or ends. MCPs and CMAs do not have access to the HH provider network in MAPP HHTS. Updating this file
in MAPP HHTS does not automatically update the list posted on the website.
Format
Partner Network File Upload
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Partner NPI 1 10 10 N Numeric
2 Submitted Partner Name 11 100 110 N Alpha
3 Begin Date 111 8 118 Y MMDDYYYY, Numeric
4 Physician Indicator 119 1 119 Y Alpha (N/Y)
5 Medical Services Provider 120 1 120 Y Alpha (N/Y)
6 Hospital 121 1 121 Y Alpha (N/Y)
7 OASAS Services 122 1 122 Y Alpha (N/Y)
8 OMH Services 123 1 123 Y Alpha (N/Y)
9 HIV/AIDS Provider 124 1 124 Y Alpha (N/Y)
10 ACT 125 1 125 Y Alpha (N/Y)
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Partner Network File Upload
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
11 Community Services and Supports 126 1 126 Y Alpha (N/Y)
12 Corrections 127 1 127 Y Alpha (N/Y)
13 Housing 128 1 128 Y Alpha (N/Y)
14 Local Government Unit (LGU)/Single Point of Access (SPOA)
129 1 129 Y Alpha (N/Y)
15 Social Service District Office 130 1 130 Y Alpha (N/Y)
16 DDSO 131 1 131 Y Alpha (N/Y)
17 Residence 132 1 132 Y Alpha (N/Y)
18 OPWDD Services 133 1 133 Y Alpha (N/Y)
19 Pediatric Provider 134 1 134 Y Alpha (N/Y)
20 Early Intervention Provider 135 1 135 Y Alpha (N/Y)
21 OT/PT/Speech 136 1 136 Y Alpha (N/Y)
22 Foster Care 137 1 137 Y Alpha (N/Y)
Partner Network File Error Report
Description
This file is created upon validating or processing a Partner Network File Upload file containing at least one error. A
Partner Network File Error Report file will not be created for an uploaded network file that does not contain
rejected records. The Partner Network File Error Report file will contain one record for each record in the
uploaded Partner Network File Upload that contains an error.
Format
Partner Network File Error Report
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Submitted Line 1 6 6 Y Numeric
2 Original Record from File 7 137 143 Y Alpha
3 Error 144 20 163 Y Alpha
Editing Logic
The Error field will be populated with a description of why the record was rejected. The field will only contain one
error description. If a record hits more than one error, only the first error will be displayed in Error (field #3). This
error file contains both file format errors and logic errors. For more information on Partner Network File Upload
errors, please see Appendix B: File Error Reason Codes.
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Partner Network File Download
Description
This file contains the information submitted into the system by the HH on the Partner Network File Upload file, in
addition to a few fields added to the file by DOH to provide official NYS Medicaid information regarding the
provider, if applicable.
Format
Partner Network File Download
Field # Field Start Pos Length End Pos
Required (Y/N/C-
conditional) Format
1 Partner NPI 1 10 10 C Numeric
2 Is Partner NPI enrolled in NYS Medicaid?
11 1 11 Y
Alpha (N/Y)
3 Name associated with Partner NPI per NYS Medicaid
12 70 81 C
Alpha
4 Submitted Partner Name 82 100 181 C Alpha
5 Begin Date 182 8 189 Y MMDDYYYY, Numeric
6 Physician Indicator 190 1 190 Y Alpha (N/Y)
7 Medical Services Provider 191 1 191 Y Alpha (N/Y)
8 Hospital 192 1 192 Y Alpha (N/Y)
9 OASAS Services 193 1 193 Y Alpha (N/Y)
10 OMH Services 194 1 194 Y Alpha (N/Y)
11 HIV/AIDS Provider 195 1 195 Y Alpha (N/Y)
12 ACT 196 1 196 Y Alpha (N/Y)
13 Community Services and Supports 197 1 197 Y Alpha (N/Y)
14 Corrections 198 1 198 Y Alpha (N/Y)
15 Housing 199 1 199 Y Alpha (N/Y)
16 Local Government Unit (LGU)/Single Point of Access (SPOA)
200 1 200 Y Alpha (N/Y)
17 Social Service District Office 201 1 201 Y Alpha (N/Y)
18 DDSO 202 1 202 Y Alpha (N/Y)
19 Residence 203 1 203 Y Alpha (N/Y)
20 OPWDD Services 204 1 204 Y Alpha (N/Y)
21 Pediatric Provider 205 1 205 Y Alpha (N/Y)
22 Early Intervention Provider 206 1 206 Y Alpha (N/Y)
23 OT/PT/Speech 207 1 207 Y Alpha (N/Y)
24 Foster Care 208 1 208 Y Alpha (N/Y)
Editing Logic
Is Partner NPI enrolled in NYS Medicaid? (field #2) and Name associated with Partner NPI per NYS Medicaid (field
#3) are added to this file by DOH, for NPIs submitted on the Partner Network File Upload file that are enrolled in
NYS Medicaid. If a submitted NPI is not enrolled in NYS Medicaid, then field 2 will be N and field 3 will be blank.
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Provider Relationship Download File
Description
This file can be downloaded by MCPs, HHs and CMAs through the File Download screen. Based on a user’s
Provider ID and role, this file contains a provider’s relationships (MCP to HH, HH to CMA) that are active, closed,
and cancelled.
Format
Provider Relationship Download File
Field # Field Start Pos Length
End Pos Format
1 Managed Care Plan 1 40 40 Alpha
2 MCP MMIS ID 41 8 48 Numeric
3 Health Home 49 40 88 Alpha
4 HH MMIS ID 89 8 96 Numeric
5 Care Management Agency 97 40 136 Alpha
6 CMA MMIS ID 137 8 144 Numeric
7 Begin Date 145 8 152 MMDDYYYY, Numeric
8 End Date 153 8 160 MMDDYYYY, Numeric
9 Relationship Status 161 8 168 Alpha
10 Reason 169 40 208 Alphanumeric
11 Auto Approval 209 3 211 Alpha
12 Direct Bill Override 212 3 214 Alpha
Editing Logic
1. This file contains all relationships that have even been documented within the system. Field #s 7-10
contain the effective dates of the relationship, the relationship status, and why a closed relationship
ended.
2. When an MCP user downloads this file, the CMA fields (# 5 & 6) will be blank. The MCP fields (# 1 & 2)
will be populated with the user’s MCP’s MMIS Provider ID. The HH fields (# 3 & 4) will be populated with
the HHs that the MCP has ever had a relationship with.
3. When an HH user downloads this file, the CMA & MCP fields (#1,2,5,6) will be populated with the
providers that the HH has ever had a relationship with. The HH fields (# 3 & 4) will be populated with the
user’s HH’s MMIS Provider ID.
4. When a CMA user downloads this file, the MCP fields (# 1 & 2) will be blank. The HH fields (# 3 & 4) will
be populated with the HHs that the CMA has ever had a relationship with. The CMA fields (# 5 & 6) will be
populated with the user’s CMA’s MMIS Provider ID.
5. If an MMIS Provider ID is both an HH and a CMA, the Provider Relationship screen will show all
relationships associated with that MMIS provider ID. However, Provider Relationship file will only contain
the relationships associated with the user’s provider ID and role. For example:
a. MMIS Provider ID 01111111 is both an HH and a CMA. CMA 01111111 has a relationship
associated with both HH 01111111 and HH 02222222 and HH 01111111 has a relationship with
CMA 01111111, CMA 03333333, and MCP 04444444.
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b. The Provider Relationship file downloaded by a user with HH 01111111 will see the following
relationships:
i. HH 01111111 to CMA 01111111
ii. HH 01111111 to CMA 03333333
c. The Provider Relationship file downloaded by a user with HH 01111111 will see the following
relationships:
i. HH 01111111 to CMA 01111111
ii. HH 02222222 to CMA 03333333
Provider Active User Download File
Description
This file can be downloaded by MCPs, HHs and CMAs through the File Download screen. Based on a user’s
Provider ID and role, this file contains all the active users that are associated with the provider. It is the provider’s
responsibility to update this information in MAPP HHTS through the provider’s gatekeepter(s).
Format
Provider Active User Download File
Field # Field Start Pos Length
End Pos Format
1 Name 1 40 40 Alpha
2 Email Address 41 40 80 Alphanumeric
3 Area Code 81 3 83 Numeric
3 Phone Number 84 10 93 Numeric
4 Role 94 4 97 Alpha
5 Position 98 40 137 Alpha
6 Title 138## 40 177 Alpha
7 From 178## 8 185 MMDDYYYY, Numeric
8 To 186## 8 193 MMDDYYYY, Numeric
9 Status 194## 8 201 Alpha
10 Provider Name 202## 40 241 Alpha
11 MMIS Provider ID 242## 8 249 Numeric
Editing Logic
1. This file contains all active users associated with a provider within the system. Field #s 7-8 contain the
effective dates of user in the system. Field #9 contains the status of the user in the system.
2. When a provider downloads this file, Field #s 10-11 contain the provider name and MMIS Provider ID.
3. All the information contained in this file was entered into the system by the provider’s gatekeeper(s). If
information contained within this file is incorrect or outdated, please contact you provider’s gatekeeper
to correct the information.
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Appendix A: Field Descriptions Listed below are field descriptions along with acceptable values, field formatting, and editing logic (if applicable).
Please note that (Y/N) stand for Yes/No, unless otherwise stated. All other codes used within MAPP HHTS files are
defined within the field descriptions below.
This key is used on each field to show the file types that the field appears on and which direction the field is
transmitted.
AD Assessment Download MFA MCP Final HH Assignment BSD Billing Support Download MMD My Members Download BSE Billing Support Error PND Partner Network Download BSU Billing Support Upload PNE Partner Network Error CD CIN Search Download PNU Partner Network Upload CRD Child Referral Download PAD Past Assignments Download CF Consent Download PP Program Participation Download File CE Consent Error PRD Provider Relationship Download File CU Consent Upload PU Program Participation Upload File ED Enrollment Download PE Program Participation Error File EFA Error Report: MCP Final HH Assignment TFA Tracking File Assignment Records HHA Health Home Assignment TFE Tracking File Error MA Managed Care Plan Assignment TFS Tracking File Segment Records MAD Manage Assignments Download TFD Tracking File Delete Record AD Assessment Download MMD My Members Download BSD Billing Support Download PND Partner Network Download BSE Billing Support Error PNE Partner Network Error BSU Billing Support Upload PNU Partner Network Upload CD CIN Search Download PAD Past Assignments Download CRD Child Referral Download PAU Provider Active User Download File CF Consent Download PP Program Participation Download File CE Consent Error PRD Provider Relationship Download File CU Consent Upload PU Program Participation Upload File ED Enrollment Download PE Program Participation Error File EFA Error Report: MCP Final HH Assignment TFA Tracking File Assignment Records HHA Health Home Assignment TFE Tracking File Error MA Managed Care Plan Assignment TFS Tracking File Segment Records MAD Manage Assignments Download TFD Tracking File Delete Record MFA MCP Final HH Assignment ↑ Files Uploaded to MAPP HHTS ↓ Files Downloaded from MAPP HHTS
ACT (Assertive Community Treatment) ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: This field is submitted to the Partner Network section of the system by HHs. HHs use this field to
indicate providers in an HH’s network that operate Assertive Community Treatment programs. The ACT indicator
field included in the Partner Network Download file comes from the value submitted on the Partner Network
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Upload file. For more information on ACT services, please visit the NYS Office of Mental Health Assertive
Community Treatment website: https://www.omh.ny.gov/omhweb/act/
Editing Logic: This field must contain a value of either N or Y on the Partner Network Upload file or the record will
be rejected. The system does not validate that an NPI submitted with a value of ‘Y’ in the ACT field is an ACT
provider according to NY Medicaid.
ACT Member ↓CD ↓BSD ↑BSU
Field Length: 1
Format: Alpha (N/Y)
Description: On billing files, this field is submitted by CMAs or by HHs on behalf of CMAs. Providers use this field to
indicate members that are ACT (Assertive Community Treatment) members during the billing instance service
month. This field remains on the BSU and BSD files although ACT members are no longer part of the HH program.
For more information on ACT services, please visit the NYS Office of Mental Health Assertive Community
Treatment website: https://www.omh.ny.gov/omhweb/act/.
On CIN Search Download file, this field indicates whether or not the member is identified on the OMH file as
currently being enrolled in the ACT program.
Editing Logic: If a provider submits a record with a value of ‘Y’ in the ACT Member field in the Billing Support
Upload file for a billing instance associated with a CMA that is not an ACT provider, then the system will accept the
record, but will ignore the ‘Y’ value submitted in the ACT Member field in the Billing Support Upload file.
ACT Minimum Services Provided ↓BSD ↑BSU
Field Length: 1
Format: Alpha (N/Y)
Description: This field is used by ACT providers to indicate whether or not their Health Home enrolled members
received the minimum required ACT services. This field remains on the BSU and BSD files although ACT members
are no longer part of the HH program. For more information on ACT services, please visit the NYS Office of Mental
Health Assertive Community Treatment website: https://www.omh.ny.gov/omhweb/act/
Editing Logic: If ACT Member (field #22) on the Billing Support Upload file contains a value of ‘Y’, then ACT
Minimum Services Provided (field #23) must be populated with either ‘Y’ for yes, the minimum required services
were provided or ‘N’ for no the minimum required services were not provided. If ACT Member (field #22) of the
Billing Support Upload file contains a value of ‘N’, then this field should be blank and the system will ignore any
value populated in this field.
Actor ↓MAD
Field Length: 40
Format: Alpha
Description: The provider that needs to act on the pended or pending assignment.
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Editing Logic: If a CMA user refers a mainstream MCP member into the Health Home program using the Create
Referral/Segment link (the “adult referral wizard”), then that member’s MCP will be listed in the Actor field on the
MAD file when the MCP downloads the MAD file.
Additional Info on Chronic Conditions ↓CRD
Field Length: 300
Format: Alpha
Description: This field includes any free text response entered under the chronic Conditions page of the Children’s
Referral Portal.
Editing Logic: This field is required when a value of 16: other is submitted in the Pre-Conditions of member field.
Add/Void Indicator ↓BSD ↑BSU
Field Length: 1
Format: Alpha (A/V) or Blank
Description: This field is used to indicate that a billing instance should move either from a potential billing instance
(blank value in field) to an added billing instance (value of ‘A’ in the field) or from an added billing instance to a
voided billing instance (value of ‘V’ in the field).
Editing Logic: The submission of a Billing Support Upload file with an Add/Void Indicator value of ‘V’ does not
delete the previously uploaded record with an Add/Void Indicator value of ‘A’, it only adds an additional record to
the Billing Support Download file showing that the previously added billing instance must be voided. For a detailed
explanation of how this field works, please see the Billing Support Download section of this document.
Adjusted Acuity Score as of Service Date ↓MMD↓BSD ↓HHA ↓MA
Field Length: 7
Format: 00.0000, Numeric
Description: For service dates on or after 12/1/16 the adjusted acuity score is obsolete as billing is based on HML
Responses or CANS acuity outcomes (same as Acuity Score). This value is nulled out on the Health Home
Assignment File and Managed Care Plan Assignment File and Billing Support Download File.
AH Member continues to qualify ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: This field is required for impacted adult home class members that have transitioned or are interested in transitioning. If a member is not an impacted adult home class member, then this field will be ignored on the BSU and will be blank on the BSD. Please refer to the Adult Home Transition Guidance to determine if the member continues to qualify for the Adult Home Plus Care Management. If the member continues to qualify, submit a value of ‘Y’ on the BSU. If the member does not continue to qualify, submit a value of ‘N’ on the BSU.
AH Member interested in transitioning ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
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Description: This field is required on the BSU if the AH Member transitioned to community field is populated with
a value of ‘N’. If the AH Member transitioned to community field is populated with a value of ‘Y’ or is not
required, then this field will be ignored on the BSU and will be blank on the BSD. If the member is interested in
transitioning out of the adult home, submit a value of ‘Y’ on the BSU. If the member is not interested in
transitioning out of the adult home, submit a value of ‘N’ on the BSU.
AH Member qualifies for Adult Home Plus Care Management ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: This field is required for all impacted adult home class members. If a member is not an impacted
adult home class member, then this field will be ignored on the BSU and will be blank on the BSD. Please refer to
the Adult Home Plus Attestation and Guidance to determine is a member qualifies for adult home plus care
management. If the member does qualify, submit a value of ‘Y’ on the BSU. If the member does not qualify,
submit a value of ‘N’ on the BSU.
AH Member transitioned to community ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: This field is required for all impacted adult home class members. If a member is not an impacted
adult home class member, then this field will be ignored on the BSU and will be blank on the BSD. If the member
has not yet transitioned out of the adult home, submit a value of ‘N’ on the BSU. If the member has already
transitioned out of the adult home, submit a value of ‘Y’ on the BSU.
AOT Member ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: If a member is court ordered into an Assisted Outpatient Treatment (AOT) program, then this field
must be populated with a value of ‘Y’ to indicate that the member is court ordered into an AOT program. If a
member is not court ordered into an AOT program, then this field must be populated with a value of ‘N’ to indicate
that the member is NOT court ordered into an AOT program.
For more information on the AOT program, please visit the Office of Mental Health AOT website at:
https://www.omh.ny.gov/omhweb/resources/publications/aot_program_evaluation/
AOT Minimum Services Provided ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: If a member is identified as court ordered into an Assisted Outpatient Treatment (AOT) program, then
the provider must indicate in this field whether or not the member received the minimum services required for an
AOT member. For more information on the AOT program, please visit the Office of Mental Health AOT website at:
https://www.omh.ny.gov/omhweb/resources/publications/aot_program_evaluation/
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Editing Logic: If AOT Member (field #20) of the Billing Support Upload file contains a value of ‘Y’, then Billing
Support Upload AOT Minimum Services Provided (field #21) must be populated with either a value of ‘Y’ or ‘N’. If
AOT Member (field #20) of the Billing Support Upload file contains a value of ‘N’, then this field should be blank
and the system will ignore any value populated in this field.
Assessment Outcome ↓AD
Field Length: 1
Format: Alpha (C/N/H/M/L)
Description: This field indicates LOC/non-LOC for HCBS records and acuity for CANs-NY records
Assessment Type ↓AD
Field Length: 1
Format: Alpha (C/H)
Description: This field indicates if the record is referring to a CANs-NY Assessment or a child HCBS Assessment
Editing Logic: If the record is referring to a CANs-NY assessment then this field will be populated with ‘C’, if the
record is referring to a child HCBS assessment then this field will be populated with ‘H’.
Assessor Organization MMIS ID ↓AD
Field Length: 8
Format: Numeric
Description: This field indicates the organization MMIS ID of the assessor who completed the UAS assessment in
the UAS.
Assessor Organization Name ↓AD
Field Length: 40
Format: Alpha
Description: This field indicates the organization name the assessor who completed the UAS assessment is
associated with in UAS.
Assigned HH MMIS Provider ID ↓CD
Field Length: 8
Format: Numeric
Description: The MMIS ID of the Health Home that has an assignment with the member in MAPP HHTS.
Assigned HH Name ↓CD
Field Length: 40
Format: Alphanumeric Description: The Health Home name associated with the Assigned Health Home MMIS Provider ID per NYS Medicaid data.
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Assigned HH Assignment Status ↓CD
Field Length: 40
Format: Alpha
Description: (same as Health Home Assignment Status)
Assignment Created Date ↓MMD ↓PAD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a member assignment began in the pending status with a specific provider. See the My
Members section for a description of how the system determines which provider’s assignment created date to
include on the file.
Assignment End Date ↓PAD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that an assignment ends.
Assignment End Reason Code ↓PAD
Field Length: 2
Format: Alphanumeric Accepted Values: Appendix G: Assignment End Date Reason Codes
Description: A code that corresponds to the reason that a member’s assignment ended. Depending on the action
that triggered the ending of the assignment, this code is either submitted into the system by a user or is generated
by the system.
Assignment End Date Reason Description ↓PAD
Field Length: 40
Format: Alpha
Description: The Assignment End Date Reason Code’s corresponding description.
Assignment Rejection Date ↓PAD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a user rejected a pending assignment (assignment, referral or transfer record type). If
the pending assignment was rejected using a file upload, then this field would be populated with the date that the
file was uploaded into the system.
Assignment Rejection Reason Code ↓PAD
Field Length: 2
Format: Alphanumeric
Accepted Values: Appendix E: Assignment Rejection Reason Codes
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Description: A code that corresponds to the reason that a user rejected a pending assignment.
Assignment Rejection Reason Code Description ↓PAD
Field Length: 40
Format: Alpha
Description: The Rejection Reason Code’s corresponding description.
Assignment Source ↓MA↓HHA↓MMD
Field Length: 20
Format: Alpha (DOH Identified, MCP Identified, Referral)
Description: Members that were identified as HH eligible by DOH are listed as ‘DOH Identified’. Members that
were identified as HH eligible by the MCP, not assigned to the MCP by DOH, are listed as ‘MCP Identified’.
Members that referred into the Health Home program through the referral wizard, Children’s Referral Portal or
members that entered into the Health Home program in a segment that contained a value of ‘R’ in the Referral
Indicator field are listed as ‘Referral’. This value is nulled out on the Health Home Assignment File and Managed
Care Plan Assignment File.
Assignment Start Date ↓MMD ↓PAD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a member assignment began in the active status with a specific provider.
Auto Approval ↓PRD
Field Length: 3
Format: Alpha, Values include Yes, No, Blank
Description: This field indicates if a CMA can create an active segment without a HH needing to approve this in MAPP.
Base Acuity Score as of Service Date ↓BSD
Field Length: 7
Format: 00.0000, Numeric
Description: Field is obsolete and has been nulled out.
Begin Date ↓AD ↓CD ↓ED ↓MMD ↓PND ↓PRD ↑PNU ↓TFE ↑TFS ↑TFD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The begin date indicates when a value or a status becomes effective.
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Editing Logic: This field must contain a valid date. On the TFS file the begin date must be greater than or equal to
the assignment date for the segment to be submitted without an ‘R’ Referral Indicator (adults only, children
cannot be referred via files). The begin date must always be the first day of the month. For example, if the member
received services on May 10, 2013, the Begin Date must be 5/1/13. This date may not fall within an existing service
segment; must fall within the HH and CMA’s provider effective dates; and must fall within the HH/CMA
relationship effective dates.
Billing Entity MMIS ID ↓BD
Field Length: 8
Format: Numeric
Description: This field is calculated by the system.
Editing Logic: As of 12/1/16 this field is obsolete and should not be referenced.
Billing Entity Name ↓BD
Field Length: 40
Format: Alphanumeric
Description: The name associated with the Billing Entity MMIS ID within NYS Medicaid’s Medicaid Data
Warehouse. As of 12/1/16 this field is obsolete and should not be referenced.
CANs Completion Date ↓BSD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date the CANs-NY assessment was signed and finalized in UAS.
CMA MMIS Provider ID ↓BSD ↓CD ↓ED ↓HHA ↓MA ↓MMD ↑TFA ↑TFE ↑TFS
Field Length: 8
Format: Numeric
Description: The MMIS Provider ID of the CMA performing Health Home services (same as Care Management
Agency MMIS ID, Care Management Agency MMIS Provider ID, Care Management Agency Provider ID, CMA
Provider MMIS ID and Assigned CMA MMIS Provider ID).
Editing Logic: On the Tracking File Segment Records upload file, this field must contain a valid MMIS Provider ID
that has a completed BAA with the Health Home listed on the record or the record will be rejected. Once a
completed BAA is submitted to DOH and approved by DOH, DOH documents that HH/CMS relationship within the
MAPP HHTS.
CMA Name ↓HHA ↓MA ↓MMD ↓ED ↓BSD ↓CD
Field Length: 40
Format: Alphanumeric
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Description: The name associated with the CMA MMIS provider ID in the NYS MDW (same as Assigned Care
Management Agency Name).
Child HCBS Flag ↓HHA ↓MA
Field Length: 1
Format: Alpha (O/N/H)
Description: Indicates if the child member was referred to the HH program for HCBS services.
Editing Logic: If the member was referred into the HH program for HCBS and does not have any other qualifying
conditions for HHs (based on information provided during referral) this field will display O. If the member has both
HCBS and other qualifying conditions this field will display H. If the member has was not referred for HCBS
eligibility but has other chronic conditions, it will display ‘N’.
Child HCBS Flag Based on R/E Code
↓ED
Field Length: 1
Format: Alpha (Y/N)
Description: Indicates if the child member has an active K1 R/E code relating to HCBS services within the system as
of the file download.
Child in Foster Care ↑BSU↓BSD
Field Length: 1 Format: Alpha (Y/N) Description: Indicates if a child is in foster care.
Chronic Conditions ↓CRD
Field Length: 100
Format: Alpha
Description: Indicates if the child member was referred into the program for chronic conditions, and if so what
chronic conditions.
City ↓ MMD ↓MA ↓HHA
Field Length: 40
Format: Alphanumeric (MMD), Alpha (MA/HHA)
Description: The most recent member contact information from NYS Medicaid’s MDW. If this information is
incorrect, the member must correct this information within NYS Medicaid. For more information on how to update
Medicaid information, see Appendix L: Reference and Contacts (same as MDW Member City).
Claim Status ↓BSD
Field Length: 1
Format: Alpha (P/D/V/Blank)
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Description: This field is populated if the system determines that there is a NYS Medicaid claim or encounter
associated with the member’s added billing instance service date. Please see the Billing Support Download File:
Description section for an explanation of how the system identifies a claim or encounter that is associated with a
member’s added billing instance service date. Please note: it may take up to a week for a claim submitted to NYS
Medicaid to be available to the MAPP HHTS.
A value of ‘P’ in this field means that the claim was paid. A value of ‘D’ in this field means that the claim was
denied. A value of ‘V’ means that the claim as voided. If an associated claim has not been submitted to NYS
Medicaid, then this field will be blank.
CMA Assignment Created Date ↓HHA ↓MA ↓MMD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a member’s CMA assignment began in the pending status with a specific CMA. This field
would be populated with information from the most recent CMA assignment record for a member.
CMA Assignment End Date ↓HHA ↓MA
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date the CMA assignment was ended.
CMA Assignment End Reason Code ↓HHA ↓MA
Field Length: 2
Format: Numeric
Accepted Values: See Appendix G: Assignment End Reason Codes
Description: A code that corresponds to the reason that a member’s CMA assignment ended. Depending on the
action that triggered the ending of the CMA assignment, this code is either submitted into the system by a user or
is generated by the system (same as CMA Assignment End Reason).
CMA Assignment End Reason Code Description ↓HHA ↓MA
Field Length: 40
Format: Alpha Description: The CMA Assignment End Reason Code’s corresponding description.
CMA Assignment Record Type ↓HHA ↓MA
Field Length: 10
Format: Alpha (Assignment, Referral, Transfer)
Description: This field is utilized to identify the different types of CMA assignments in the system: Assignment,
meaning the member was assigned to the CMA by a HH; Referral, which means that the member assignment
resulted from a community referral; and Transfer, which means that the member’s current HH is asking if the
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receiving provider will accept the member as a Transfer or another HH is asking for the current provider to transfer
a member to them. This field is used to indicate the record’s CMA assignment type.
CMA Assignment Rejection Reason Code ↓HHA ↓MA
Field Length: 2
Format: Numeric Accepted Values: See Appendix E: Assignment Rejection Codes
Description: A code that corresponds to the reason that a member’s pending CMA assignment was rejected by the
assigned CMA. Depending on the action that triggered the rejection of the CMA assignment, this code is either
submitted into the system by a user or is generated by the system.
CMA Assignment Rejection Reason Code Description ↓HHA ↓MA
Field Length: 40
Format: Alpha
Description: The CMA Assignment Rejection Reason Code’s corresponding description
CMA Assignment Start Date ↓HHA ↓MA
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a member’s CMA assignment began in the active status with a specific CMA. This field
would be populated with information from the most recent CMA assignment record for a member.
CMA Assignment Status ↓HHA ↓MA ↓CD
Field Length: 40
Format: Alpha (Pending, Active, Rejected, Ended, or Blank)
Description: This field describes the status of a member’s assignment with their CMA. Pending means the member
was assigned to the CMA and that the CMA has not yet acted on that assignment. Active means that the CMA
accepted the member’s pending assignment. Ended means that the member’s CMA assignment was ended and
would only apply to MCP/HH downloading the file. The Rejected status only applies to HHs and MCPs. If an MCP
or a HH sees that a member has a value of rejected in the CMA Assignment Status field, then the MCP or HH
knows that the CMA that the HH assigned the member to reject that assignment (same as Assigned CMA
Assignment Status.)
CMA Direct Biller Indicator ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: For dates of service on or after 12/1/16 the CMA Direct Biller Indicator is obsolete as CMAs are no
longer direct billers.
CMA MMIS Provider ID ↑TFA, ↓MA
Field Length: 8
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Format: Numeric
Description: (same as Care Management Agency ID, Care Management Agency MMIS ID, Care Management
Agency MMIS Provider ID and Care Management Agency Provider ID)
Comments ↓CRD
Field Length: 300
Format: Alpha or Blank
Description: This field includes any free text response entered under the Originating Referral Source Contact
information of the Children’s Referral Portal.
Comments Related to Referral ↓CRD
Field Length: 300
Format: Alpha or Blank
Description: This field includes any free text response entered under the Consenter Contact information of the
Children’s Referral Portal.
Community Services and Supports ↑PNU ↓PND
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that provide community services, including but not limited to, food banks, religious
organizations, community centers.
Consent Date ↓CF ↓ED ↓MMD ↑TFS
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field is no longer valid on the↓ED ↓MMD ↑TFS , and the Consent file should be used to view
and capture consents.
On the ↓CF, this is the most recent date the consent record was created or updated.
Consenter ↑CU ↓CF ↓CE
Field Length: 2
Format: Numeric Accepted Values: See Appendix M: Consent File Codes
Description: This field indicates who signed the consent.
Consenter Area Code ↓CRD
Field Length: 3
Format: Numeric
Description: The area code of the person that provided consent for the member to be referred to the HH Program. This information is retrieved from the most recent referral for the member that was submitted via the Children’s Referral Portal.
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Consenter Email Address ↓CRD
Field Length: 40
Format: Alpha
Description: The identified email address of the person that provided consent for the member to be referred to the HH Program. This information is retrieved from the most recent referral for the member that was submitted via the Children’s Referral Portal.
Consenter First Name ↓CRD
Field Length: 30
Format: Alpha
Description: The first name of the person that provided consent for the member to be referred to the HH Program. This information is retrieved from the most recent referral for the member that was submitted via the Children’s Referral Portal.
Consenter Last Name ↓CRD
Field Length: 30
Format: Alpha
Description: The last name of the person that provided consent for the member to be referred to the HH Program. This information is retrieved from the most recent referral for the member that was submitted via the Children’s Referral Portal.
Consenter Phone Number ↓CRD
Field Length: 7
Format: Numeric
Description: The phone number of the person that provided consent for the member to be referred to the HH Program. This information is retrieved from the most recent referral for the member that was submitted via the Children’s Referral Portal.
Consenter Preferred Communication ↓CRD
Field Length: 5
Format: Alpha
Description: The identified preferred method of communication of the person that provided consent for the member to be referred to the HH Program. This information is retrieved from the most recent referral for the member that was submitted via the Children’s Referral Portal.
Consenter Pref. Time of Day ↓CRD
Field Length: 9
Format: Alpha
Description: The identified preferred time of day for communication with the person that provided consent for the member to be referred to the HH Program. This information is retrieved from the most recent referral for the member that was submitted via the Children’s Referral Portal.
Consenting Individual to Refer ↓CRD
Field Length: 95
Format: Alpha
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Description: Includes the consenter’s relationship with the member selected on the Consenter screen from the
most recent referral via the Children’s Referral Portal. The possible values are: Parent, Guardian, Legally
Authorized Representative, Member/Self Individual is 18 years old or older, Member/Self Individual is under 18
years old, but is a parent, or is pregnant, or is married.
Consent Type ↑CU ↓CD ↓CE
Field Length: 2
Format: Numeric (01, 02, 03) Accepted Values: See Appendix M: Consent File Codes
Description: Populate this field with the type of consent that was signed (same as Existing Consent Type and New
Consent Type).
Core Service Provided ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: Providers populate this filed with a value of ‘Y’ if the member received at least one core service during
the service month. If the member did not receive a core service within the service month, then this field must be
populated with a value of ‘N’. For more information on what constitutes a Health Home core service, please see
the Health Homes Provider Manual: Billing Policy and Guidance document available at the link in Appendix L.
Corrections ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that are associated with corrections and/or Office of Criminal Justice services.
County of Fiscal Responsibility Code ↓HHA ↓MA ↓MMD ↓BSD
Field Length: 2
Format: Numeric
Description: The NYS Medicaid’s county code for the county that is fiscally responsible for the Medicaid member
(same as Member Fiscal County Code).
County of Fiscal Responsibility Description ↓HHA ↓MA ↓MMD ↓BSD
Field Length: 30
Format: Alpha
Description: The description of the County of Fiscal Responsibility Code (same as County of Fiscal Responsibility
Desc and Member Fiscal County Code Description).
Created By ↓MAD
Field Length: 40
Format: Alpha
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Description: The provider that created the pending assignment listed on the MAD file. Editing Logic: If a CMA user refers an MCP member into the Health Home program using the Create Referral/Segment link (the “referral wizard”), then that CMA will be listed in this field on the MAD file when the MCP downloads the MAD file.
Created Date ↓MAD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: Same as Assignment Created Date.
Current HARP Status ↓BSD
Field Length: 2
Format: Alpha (Blank, EL, or EN)
Description: HARP stands for Health and Recovery Plans, which is a Managed Care Plan that covers certain Medicaid
members that meet the HARP eligibility criteria. For more information regarding HARP, please follow the link
below to the NYS Office of Mental Health’s Behavioral Health Transition to Managed Care website.
https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/index.htm A value of ‘EL’ means
that the member has been identified by DOH as HARP eligible, but that the member is not yet officially enrolled in
a HARP. A value of ‘EN’ means that the member is officially enrolled in a HARP. If this field is blank, it means that
the member is neither enrolled in a HARP nor identified by DOH as HARP eligible. However, if this field is blank it
does not mean that the member has been deemed ineligible for HARP enrollment. HARP eligibility and enrollment
is determined by RE codes and enrollment in a HARP MCP line of business.
Current MCP MMIS Provider ID ↓ED
Field Length: 8
Format: Numeric
Description: This field displays the MMIS ID of the Managed Care Plan the member is associated with as of the date
the Enrollment Download file is downloaded, which may be different from the Managed Care Plan the member
was associated with during the segment period. This field will be blank for members that are currently fee for
service. This field corresponds to the Current MCP Name field on the Enrollment Download file.
Current MCP Name ↓ED
Field Length: 40
Format: Alpha
Description: This field displays the name of the Managed Care Plan the member is associated with as of the date
the Enrollment Download file is downloaded, which may be different from the Managed Care Plan the member
was associated with during the segment period. This field will be blank for members that are currently fee for
service.
Date ↓CF
Field Length: 8
Format: MMDDYYYY, Numeric
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Description: The most recent date the consent record was created or updated.
Date of Birth ↓BSD ↓CD ↓ED ↓MMD ↓HHA ↓MA ↓PAD ↑TFS ↓CRD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field is populated with the most recent member information available from NYS Medicaid. If the
NYS Medicaid information is incorrect, then the member must update the information with NYS Medicaid. Please
see Appendix L: Reference and Contacts for information on how a member can update this information with NYS
Medicaid. Please note: it may take up to a week for information corrected in NYS Medicaid’s MDW to be listed
within the MAPP HHTS (same as DOB and Member DOB).
Editing Logic: On file uploads, this field must contain a valid date that matches the information that is on file
within NYS Medicaid’s MDW. If the information in NYS Medicaid’s MDW is incorrect, then the uploaded file must
match the incorrect information that is listed in MDW until that incorrect information is corrected with NYS
Medicaid.
Date HML Assessment Entered ↓BSD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This is the date that the High, Medium, Low Assessment was completed for a member’s service date.
For HML submitted to the system on a file, this field is populated with the date that the file was uploaded. For
HML information entered online, this field is populated with the date that the online HML assessment was
completed.
Editing Logic: This field will only contain a value if the HML Assessment was completed for the member’s service
date.
Date Member Housed ↓BSD ↑BSU Field Length: 8
Format: MMDDYYYY, Numeric
Description
Date of Patient Acuity ↓HHA ↓MA ↓MMD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field will show the time period that the acuity and rank information is based on. Patient Acuity is
obsolete. This field is nulled out on the Health Home Assignment File and Managed Care Plan Assignment File.
Date of Transaction ↓BSD
Field Length: 8
Format: MMDDYYYY, Numeric
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Description: This field is populated with the date the claim or encounter was submitted to NYS Medicaid if the
system determines that there is a NYS Medicaid claim or encounter associated with the member’s added billing
instance service date. Please see the Billing Support Download File: Description section for an explanation of how
the system identifies a claim or encounter that is associated with a member’s service date.
DDSO ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that are Developmental Disabilities Services Offices.
Denial Reason Code/ Denial Reason Code (2) ↓BSD
Field Length: 4
Format: Numeric
Description: This field is populated if the system determines that there is a denied NYS Medicaid claim or
encounter associated with the member’s added billing instance service date. Please see the Billing Support
Download File: Description section for an explanation of how the system identifies a claim or encounter that is
associated with a member’s service date.
The denial reason code is pulled by the system from eMedNY and represents a specific reason why a claim or
encounter was denied by NYS Medicaid. The system will display up to two denial edit reasons. If a claim hits three
or more edits, then only the first two denial edits will be displayed.
Denial Reason Code Description/ Denial Reason Code Description (2) ↓BSD
Field Length: 25
Format: Alphanumeric
Description: This field is populated if the system determines that there is a NYS Medicaid claim or encounter
associated with the member’s added billing instance service date. Please see the Billing Support Download File:
Description section for an explanation of how the system identifies a claim or encounter that is associated with a
member’s service date.
The denial reason code description is pulled by the system from eMedNY. It corresponds to a specific denial
reason code and provides a description of why a claim was denied by NYS Medicaid.
Description of "Other" pre-condition ↓BSD ↑BSU
Field Length: 40 Format: Alphanumeric
Description: If the Pre-Conditions of member (field #5) on the Billing Support Upload file contains code 16 ‘Other’,
then Billing Support Upload Description of “Other” pre-condition (field #6) must be populated with a description
of the ‘Other’ condition that qualifies the member for the Health Home program. If code 16 ‘Other’ is not included
in Billing Support Upload File Pre-Conditions of member (field #5), then this field should be blank and the system
will ignore any value populated in this field.
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Please refer to the provider manual (see Appendix L: Reference and Contacts a link to the HH Program Manual).
Diagnosis Code ↓BSD ↑BSU
Field Length: 10
Format: Alphanumeric
Description: This field is used by HH and CMA users to indicate the diagnosis code that should be included on a
member’s Health Home claim or encounter. Providers may choose if/how to use this field to exchange
information regarding the most appropriate diagnosis code that should be included on a member’s Health Home
claim or encounter for a specific service date. It is up to the appropriate biller to make the final determination
regarding which diagnosis code is the most appropriate to be included on a Health Home claim or encounter. DOH
cannot give billing providers coding advice.
Editing Logic: This field is not required. This field is a free text field that allows up to 10 characters. This field is
not edited. Submitted diagnosis code information should conform to the applicable diagnosis code set, ICD-10, as
of the record’s service date.
Direct Biller Indicator ↓CD ↓ED ↑TFS↓BSD
Field Length: 1
Format: Alpha (M/H/C) (BSD), Alpha (Y/N) (CD, ED, TFS)
Description: This field is obsolete.
Direct Bill Override ↓PRD
Field Length: 3
Format: Alpha (Y/N/Blank)
Description: This field indicates whether or not a CMA could bill. This is no longer relevant.
Disenrollment Reason Code ↓ED
Field Length: 2
Format: Numeric
Accepted Values: Appendix D: Segment End Date Reason Codes
Description: The reason why the segment was ended.
Editing Logic: This field must contain an accepted value. This field is only required for segments with an end date.
DOH Assignment Date ↓MA ↓MMD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that DOH first identified a member as HH eligible and assigned the member to an
organization.
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DOH Composite Score ↓ MMD ↓HHA ↓MA
Field Length: 6
Format: Decimal, 999V99
Description: The field has become obsolete and is nulled out on the Health Home Assignment File and Managed
Care Plan Assignment File.
DOH Recommended HH MMIS Provider ID ↓ MA ↓ MMD
Field Length: 8
Format: Numeric
Description: For each MCP member that DOH assigns to an MCP, DOH uses a member’s Medicaid claims and
encounters history and HHs’ partner networks to populate this field with the Health Home that has the best
connection with a member. If a member does not have claims and encounters in the system, or if this algorithm
shows that a member is equally connected to multiple Health Homes, then the algorithm randomly assigns the
member to a regional Health Home. MCPs can either assign their members to this HH or MCPs can assign
members to Health Homes using their own knowledge of the member (same as DOH Recommended HH). This
value is nulled out on the Managed Care Plan Assignment File.
DOH Recommended Health Home Name ↓MA
Field Length: 40
Format: Alpha
Description: The name associated with a DOH Recommended Health Home MMIS ID within the NYS Medicaid
MDW.
Downloading Provider Assignment Created Date ↓MMD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that the member’s assignment began with the provider downloading the file.
Downloading Provider Assignment Start Date ↓MMD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field is populated with the start date of the downloading provider’s most recent reportable assignment that is in the active or pended status. This field is always blank for segment records.
Downloading Provider Assignment Status ↓MMD
Field Length: 40
Format: Alpha (Pending, Pended, Active)
Description: This field is populated with the status (pending, pended, active) of the downloading provider’s most recent reportable assignment record. This field is always blank for segment records.
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Early Intervention Provider ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that provide early intervention services to children.
Eligible for Outreach ↓HHA ↓MA
Field Length: 1
Format: Alpha (Y/N) Description: This field indicates whether or not a member has had 2 or more months of outreach in a status other than Cancelled within the last 12 months. Effective 7/1/20, outreach is no longer a Medicaid covered service.
Encounter Claim ↓BSD
Field Length: 1
Format: Alpha (C, E, or blank) Description: Refers to the payment information contained in fields 57-68 of the Billing Support Download. C indicates that the Health Home was paid on a fee for service claim through eMedNY. E indicates that the Health Home was paid by the member’s Managed Care Plan. Plans are required to submit encounters to DOH to document what the Managed Care Plan paid a downstream provider. Generally, since encounters are reported to DOH by the Plans, it takes a little longer for encounters to be displayed on the Billing Support Download file than the claims.
End Date ↓AD ↓CD ↓ED ↓MMD ↓PRD ↑TFS ↑CU ↓CF ↓CE
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The end date indicates when a value or a status becomes no longer effective.
Editing Logic: This field must contain a valid date. On the TFS file, the end date must always be the last day of the
month. For example, if the services ended on May 10, 2016, the End Date must be 5/31/16. This date may not fall
within an existing service segment.
The End Date indicates when the segment or consent ended. When a member dis-enrolls from Health Home
services, the end date will indicate when Health Home services were discontinued. Unless a member is moving
from outreach to enrollment or from pended to enrollment (with the same HH and CMA), an end date must be
submitted using a modify record to indicate to DOH that a segment is ending. When a member is moving from
outreach to enrollment or pended to enrollment, an end date is not needed to end date the outreach or pended
segment. When a Create record for enrollment is submitted, the system will automatically end date any outreach
or pended segments that are open as of the submitted end date.
Editing Logic: This date must be greater than the begin date and must always be the last day of the month. When
a segment is ended, the segment must be ended using a modify record, never a delete record. The end date
cannot cause the segment to overlap with another existing segment. For open segments, the end date field should
be null.
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End Date Reason/Assignment End Date Reason Description ↓HHA ↑TFA ↓MMD
Field Length: 2 (reason code)/60 (description)
Format: See Appendix G: Assignment End Reason Codes
Description: Providers use acceptable codes to describe why they are ending the member’s assignment.
End Date Reason Comment/Assignment End Date Reason Comment ↓HHA ↓MA ↑TFA
Field Length: 40
Format: Alphanumeric
Description: When field End Date Reason is populated with code ‘12’ indicating ‘Other’, this field must be
populated with the reason that the provider ended the assignment. This field includes the corresponding
comments to the End Date Reason/Segment End Date Reason Description (same as End Reason Comment).
End HH Assignment ↑TFA ↑TFS
Field Length: 1
Format: Alpha (Y/N)
Description: When a provider uses the TFS file to submit a record end dating a segment, a value of ‘N’ (No – don’t end the HH assignment) in this field indicates to the system to add the member back to the Health Home’s assignment file the day after the segment ends. A value of ‘Y’ (Yes –end the HH assignment) in this field indicates to the system NOT to add the member back to the Health Home’s assignment file the day after the segment ends. When a provider uses the TFA file to submit a record to end a CMA assignment, a value of ‘N’ (No – don’t end the HH assignment) indicates that the system should just end the member’s assignment with the CMA, but not the HH and a value of ‘Y’ means that the system should end the member’s assignment with both the CMA and the HH.
Segment End/Pend Reason Code
↑TFS
Field Length: 2
Format: Numeric Accepted Values: See Appendix D: Segment End Date Reason Codes
Description: The reason why the segment is being end dated. This field should be left blank if the segment is open.
Editing Logic: This field must contain an accepted value. This field is only required for segments with an end date.
Engagement Optimization ↓MA ↓HHA ↑MFA
Field Length: 1
Format: Alpha Accepted Values: Appendix K: MCP Final HH Assignment File Accepted Values Description: Indicates if a member is part of a MCP’s engagement-optimization plan and describes how an MCP has
engaged a member. This field is optional for MCPs.
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Enrolled CMA MMIS Provider ID ↓CD
Field Length: 8
Format: Numeric
Description: The MMIS ID of the CMA the member is enrolled with. If the member is not enrolled, this field will be
blank
Enrolled CMA Name ↓CD
Field Length: 40
Format: Alphanumeric
Description: The name in NYS Medicaid that corresponds to the Enrollment Care Management Agency MMIS
Provider ID.
Error Reason Code 1-5 ↓TFE
Field Length: 8
Numeric: Numeric
Description: The code that corresponds to the Error Reason Description.
Error Reason/Error Reason Description 1-5 ↓BSE ↓TFE ↓BE ↓EFA ↓CE ↓PNE ↓PE
Field Length: 30 (EFA,CE, PE); 40 (BSE); 70 (TFE); 20 (PNE)
Format: Alphanumeric (EFA,CE, PE, BSE); Alpha (BFE) Accepted Values: Appendix B: File Error Reason Codes
Description: The Error Reason field will be populated with a description of why the record was rejected. The field
will only contain one error description, so if a record hits more than one error, only the first error will be displayed
in the Error Reason field (same as Error).
Existing Start Date ↑CU ↓CE
Field Length: 8
Format: Numeric, MMDDYYYY
Description: The start date of the current consent data.
Expanded HH+ ↑BSU ↓BSD
Field Length: 1
Format: Alpha Accepted Values: Appendix H: High Medium Low Assessment Codes
Description: The Expanded HH+ Field captures information regarding if a member is part of the Expanded HH+
population (same as Expanded HH+ Population).
Finalized Date ↓AD
Field Length: 8
Format: Numeric (MMDDYYY)
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Description: This field is populated with the date the assessment was signed and finalized per UAS data.
First Name/Member First Name ↓AD ↓BSD ↓ED ↓HHA ↓MAD ↓MA ↓MMD ↓PAD ↓CD ↓CF ↓CRD
Field Length: 30
Format: Alpha
Description: This field is populated with the most recent member information available from NYS Medicaid. If the
NYS Medicaid information is incorrect, then the member must update the information with NYS Medicaid. Please
see Appendix L: Reference and Contacts for information on how a member can update this information with NYS
Medicaid. Please note: it may take up to a week for information corrected in NYS Medicaid’s MDW to be listed
within the MAPP HHTS.
Foster Care ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y) Description: This field indicates whether a provider/partner is associated with foster care services.
Gender/Member Gender ↓BSD ↓CD ↓ED ↓HHA ↓MA ↓MMD ↑TFS
Field Length: 1
Format: Alpha (M/F)
Description: This field is populated with the most recent member information available from NYS Medicaid. If the
NYS Medicaid information is incorrect, then the member must update the information with NYS Medicaid. Please
see Appendix L: Reference and Contacts for information on how a member can update this information with NYS
Medicaid. Please note: it may take up to a week for information corrected in NYS Medicaid’s MDW to be listed
within the MAPP HHTS.
Editing Logic: On file uploads, this field must contain a valid gender code that matches the information that is on
file within NYS Medicaid’s MDW. If the information in NYS Medicaid’s MDW is incorrect, then the uploaded file
must match the incorrect information that is listed in MDW until that incorrect information is corrected with NYS
Medicaid.
HARP ↓HHA ↓MA ↓ED ↓BSD ↓MMD
Field Length: 1 character (HHA, MA, ED); 2 characters (BSD, MMD)
Format: Alpha (Y/N/E - HHA, MA, ED); Alpha (EL/EN/Blank - BSD, MMD)
Description: MAPP HHTS HARP Definitions (as of July 2016) *
1.• A member that is enrolled in a HARP/SNP Managed Care Plan AND has an RE code of H1-H6 is considered HARP Enrolled in MAPP HHTS.
1.• A member that does not have an RE code of H1-H6 BUT has an RE code of H9 is considered HARP Eligible in MAPP HHTS.
2.• A member that does not have an RE code of H1-H9 is neither HARP eligible nor HARP enrolled HARP flags within the system contain different values. Some spell out eligible/enrolled/blank and others use the logic below:
Formatted: Bulleted + Level: 1 + Aligned at: 0.25" +Indent at: 0.5", Tab stops: Not at 0.5"
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➢ HARP Y/N/E fields –Y: HARP eligible; E: HARP Enrolled; N: neither eligible nor enrolled. ➢ HARP El/En/Blank fields -El: HARP eligible; En: HARP Enrolled; Blank: neither HARP eligible nor HARP
enrolled. *As of service date for billing. Otherwise, as of transaction date
HCBS Referral Indicator ↓CRD
Field Length: 30
Format: Alpha (HCBS/None)
Description: This field records if the referring provider indicated that the child record in the file was referred based
on HCBS eligibility
HH Assignment Status ↓HHA ↓MA
Field Length: 40
Format: Alpha (Pending, Active, Rejected, Ended)
Description: This field describes the status of a member’s assignment with their HH. Pending means member was
assigned or referred to the HH and that the HH has not yet acted on that assignment. Active means that the HH
either accepted the member’s pending assignment/referral or that the HH member is back on the HH assignment
file because the member had a segment that ended and the HH assignment was not ended with the segment.
Ended means that the member’s HH assignment was ended. The Rejected status only applies to MCPs. If an MCP
sees that a member has a value of rejected in the Health Home Assignment Status field, then the MCP knows that
the HH that the MCO assigned the member to reject that assignment (same as Assigned HH Assignment Status).
HH MMIS Provider ID ↓AD ↓BSD ↓CD ↓ED ↓EFA ↓HHA ↓MA ↑MFA ↓MMD ↓TFE ↑TFS ↑CU
↓CF ↓CE ↑TFA Field Length: 8
Format: Numeric
Description: An MMIS Provider ID is a unique identification number assigned to a provider by NYS Medicaid when
the provider enrolls in NYS Medicaid. The HH MMIS Provider ID is the MMIS Provider ID associated with a
provider that has been designated by DOH as a Health Home. Each designated Health Home must have a unique
MMIS Provider ID. For the Assessment Download File the HH MMIS ID is populated with the HH selected in the
UAS for CANs-NY Assessments and the HH associated with the member at the time the assessment is processed for
child HCBS members (same as Enrolled Health Home MMIS Provider ID, Health Home MMIS Provider ID, HH
Provider MMIS ID and Assigned Health Home ID).
HH Name ↓AD ↓BSD ↓ED ↓HHA ↓MA ↓MMD ↓CF ↓PRD
Field Length: 40
Format: Alphanumeric
Description: The name associated with a Health Home MMIS Provider ID within the NYS Medicaid MDW. For the
Assessment Download File, the HH Name is populated with the HH selected in the UAS for CANs-NY Assessments
and the HH associated with the member at the time the assessment is processed for child HCBS members (same as
Enrolled Health Home Name).
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HH NPI ↓HHA ↓MA
Field Length: 10
Format: Numeric
Description: The National Provider Identifier number that is associated with the Health Home’s MMIS Provider ID.
HIV/AIDS Provider ↓PND ↑PNU
Field Length: 1
Format: Alpha (Y/N)
Description: Partners that specialize in providing services to individuals with HIV/AIDS.
HIV Status ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: This field is submitted on the Billing Support Upload file to indicate if a member is HIV positive. A
value if ‘Y’ means that the member is HIV positive and a value if ‘N’ means that the member is not HIV positive. If a
provider does not know a member’s HIV status, then this field should contain a value of ‘N’.
HIV T-Cell Count ↓BSD ↑BSU
Field Length: 1
Format: Numeric
Accepted Values: Appendix H: High, Medium, Low (HML) Assessment
Description: This field collects a member’s T-Cell Count using acceptable codes. This field is part of the High,
Medium, Low (HML) Assessment and is one of the variables used to determine a member’s monthly HML rate.
Editing Logic: If HIV Status (field #7) in the Billing Support Upload file contains a value of ‘Y’, then Billing Support
Upload HIV T-Cell Count (field #9) must be populated with one of the accepted values. If HIV Status (field #7) in
the Billing Support Upload file contains a value of ‘N’, then this field should be blank and the system will ignore any
value populated in this field. If this field was not required on the BSU, this field on the BSD will contain a value of
‘0’.
HIV Viral Load ↓BSD ↑BSU
Field Length: 1
Format: Numeric
Accepted Values: Appendix H: High, Medium, Low (HML) Assessment
Description: This field collects a member’s HIV Viral Load using accepted codes. This field is part of the High,
Medium, Low (HML) Assessment and is one of the variables used to determine a member’s monthly HML rate.
Editing Logic: If HIV Status (field #7) in the Billing Support Upload file contains a value of ‘Y’, then Billing Support
Upload HIV Viral Load (field #8) must be populated with one of the accepted values. If HIV Status (field #7) in the
Billing Support Upload file contains a value of ‘N’, then this field should be blank and the system will ignore any
value populated in this field. If this field was not required on the BSU, this field on the BSD will contain a value of
‘0’.
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HH Assignment Created Date ↓HHA ↓MA
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a member assignment began in the pending status with an HH.
HH Assignment End Date ↓MA
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date the HH ended the assignment.
HH Assignment End Reason Code ↓MA
Field Length: 2
Format: Numeric
Accepted Values: Appendix G: Assignment End Date Reason Codes
Description: A code that corresponds to the reason that a member’s HH assignment is ended. Depending on the
action that triggered the ending of the HH assignment, this code is either submitted into the system by a user or is
generated by the system (See Appendix G for more information).
HH Assignment End Reason Code Description ↓MA
Field Length: 40
Format: Alpha
Description: The description that corresponds to the HH Assignment End Reason Code.
HH Assignment Record Type ↓MA ↓HHA
Field Length: 10
Format: Alpha (Assignment, Referral, Transfer)
Description: This field is utilized to identify the different types of HH assignments in the system: Assignment,
meaning the member was assigned to the HH by DOH or an MCP; Referral, which means that the member
assignment resulted from a community referral; and Transfer, which means that the member’s current HH is
asking if the receiving provider will accept the member as a Transfer or another HH is asking for the current HH to
transfer the member to them. This field is used to indicate the record’s HH assignment type.
HH Assignment Rejection Reason Code ↓MA
Field Length: 2
Format: Numeric Accepted Values: Appendix E: Assignment Rejection Reason Codes
Description: A code that corresponds to the reason that a member’s pending HH assignment was rejected by the
assigned HH. Depending on the action that triggered the rejection of the HH assignment, this code is either
submitted into the system by a user or is generated by the system .
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HH Assignment Rejection Reason Code Description ↓MA
Field Length: 40
Format: Alpha
Description: The description that corresponds with the HH Assignment Rejection Reason Code.
HH Assignment Start Date ↓MA ↓HHA Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a member’s HH assignment began in the active status with a specific HH.
HH+ Minimum Services Provided ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: Indicates if HH+ level of services were provided for a HH+ member for a specific service date (same as HH+ service provided).
Hospital ↓PND ↑PNU
Field Length: 1
Format: Alpha (Y/N) Description: Partners that are Hospitals.
Housing ↓PND ↑PNU
Field Length: 1
Format: Alpha (Y/N)
Description: Partners that provide housing services.
HUD Category ↓BSD ↑BSU
Field Length: 1
Format: Numeric Accepted Values: Appendix H: High, Medium, Low (HML) Assessment
Description: This field collects a member’s HUD Category. This field is part of the High, Medium, Low (HML)
Assessment and is one of the variables used to determine a member’s monthly HML rate.
Editing Logic: If Member Housing Status (field #10) in the Billing Support Upload file contains a value of ‘Y’, then
Billing Support Upload HUD Category (field #11) must be populated with one of the accepted values. If Member
Housing Status (field #10) in the Billing Support Upload file contains a value of ‘N’, then this field should be blank
and the system will ignore any values submitted in HUD Category (field #11). If this field was not required on the
BSU, this field on the BSD will contain a value of ‘0’.
HUD1 within Past 6 months ↑BSU
Field Length: 1
Format: Alpha (Y/N)
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Description: Indicates if the member meets the HUD 1 definition of homelessness in the past 6 months
Impacted Adult Home Class Member/Impacted Adult Home Member ↓BSD ↓MMD
Field Length: 1
Format: Alpha (Y/N)
Description: A member that is included in the Adult Home Stipulation Class Member list. These members are
identified within the MAPP HHTS by DOH.
Editing Logic: Members with a value of ‘Y’ in this field must respond to the appropriate Adult Home questions on
the Billing Support Upload file.
Incarceration ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N/U)
Description: This field is submitted on the Billing Support Upload file to indicate if a member was incarcerated, for
any reason or for any length of time, within the last year. A value of ‘Y’ means that the member was incarcerated
within the past year, a value of ‘N’ means that the member was not incarcerated within the past year, and a value
of ‘U’ means that the member was incarcerated within the past year, but that the submitting provider does not
know the member’s release date.
Incarceration Release Date ↓BSD ↑BSU
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field collects the release date for recently incarcerated members. This field is part of the High,
Medium, Low (HML) Assessment and is one of the variables used to determine a member’s monthly HML rate.
Editing Logic: If Incarceration (field #12) in the Billing Support Upload file contains a value of ‘Y’, then Billing
Support Upload Incarceration Release Date (field #13) must be populated with the date that the member was
released. The submission must be a valid date and must conform to the date format listed above. If Incarceration
(field #12) in the Billing Support Upload file contains a value of ‘N’ or ‘U’, then this field should be blank and the
system will ignore any value populated in this field.
Insert Date ↓BSD ↓ED
Field Length: 8
Format: MMDDYYYY, Numeric
Description: In the Enrollment Download File, this field signifies the first date that a record was submitted into the
system. In the Billing Support Download File, this field is always populated with the date that a member’s billing
instance is first created. For example, if a segment was created on 4/28/2017 at 11:07:23 AM with a begin date of
3/1/2017, then the system would create a potential billing instance for that member for service date 3/1/2017
with an insert date of 4/28/17 and a last transaction date/time of ‘0428201711:07:23’. If that billing instance is
then added on 4/29/2017 at 10:07:23 AM, then the system will create a new added billing instance with an insert
date of 4/28/17 and a last transaction date/time of ‘0429201710:07:23’. If that added billing instance was then
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voided on 4/29/2017 at 12:07:23 PM, then the system would create a new voided billing instance with insert date
of 4/28/17 and a last transaction date/time of ‘0429201712:07:23’. The insert date will help providers identify
newly created billing instances, regardless of service date (e.g. if a provider submits a segment on August 2nd with a
begin date of January 1, 2016, the insert date will allow the provider to look at all of the new August, billing
instances and this new segment’s January-August billing instances by filtering the insert date fields to dates on or
before August 1st).
Is Partner NPI enrolled in NYS Medicaid? ↓PND
Field Length: 1
Format: Alpha (N/Y)
Description: Indicates if the Partner NPI is enrolled in NYS Medicaid: ‘Y’ means yes, and ‘No’ means no.
Latest Modified Date ↓PAD ↓ED
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that the record was last modified.
Latest Transaction ↓BSD
Field Length: 1
Format: Alpha (Y/N)
Description: Used to indicate which Billing Instance for a member’s service date is most recent, based on date and time of the HML submission. Value of ‘Y’ means that the record is the most recent record. A value of ‘N’ means that the record is not the most recent record. For each member service date, only one record will contain a value of ‘Y’.
Last Name (Member Last Name) ↓AD ↓BSD ↓ED ↓HHA ↓MAD ↓MA ↓MMD ↓PAD ↓CD ↓CF ↓CRD
Field Length: 30
Format: Alpha
Description: This field is populated with the most recent member information available from NYS Medicaid. If the
NYS Medicaid information is incorrect, then the member must update the information with NYS Medicaid. Please
see Appendix L: Reference and Contacts for information on how a member can update this information with NYS
Medicaid. Please note: it may take up to a week for information corrected in NYS Medicaid’s MDW to be listed
within the MAPP HHTS.
Last Transaction Date Time ↓BSD
Field Length: 16
Format: MMDDYYYY:MM:SS, Numeric
Description: This field is populated with the date and time that a member’s record was last modified, regardless of
the billing instance status. If a billing instance was added on 4/28/2017 11:07:23 AM then the Last Transaction
Date/Time for that added billing instance would be ‘0428201711:07:23’.
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Last Updated By ↓CF
Field Length: 40
Format: Alpha
Description: This field is populated with the user name of the most recent user that created or updated the
consent record.
Line Number All Error Files except BSE
Field Length: 6
Format: Numeric
Description: The line number on the submitted file that was rejected (same as Submitted Line).
Local Government Unit (LGU)/Single Point of Access (SPOA) ↓PND ↑PNU
Field Length: 1
Format: Alpha (Y/N)
Description: Partners that are Local Government Units and/or Single Point of Access providers.
MCP Assignment Status ↓CD ↓HHA ↓MA
Field Length: 40
Format: Alpha (Pending, Active, Pended)
Description: This field describes the status of a member’s Health Home assignment with their MCP. Pending
means that either DOH assigned a member to the MCP or a HH/CMA referred an MCP member into the Health
Home program, and the MCP has not yet acted on that assignment. Active means that the MCP either accepted
the member’s pending assignment or that the MCP member is back on the MCP assignment file because the
member had a segment that was end dated. Pended means that the MCP reviewed the member’s pending
assignment and determined that the member was not appropriate for the Health Home program at this time.
MCP Enrollment Date ↓CD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that the member last enrolled with their current MCP within the MAPP HHTS.
MCP MMIS Provider ID ↓BSD ↓CD ↓HHA ↓MA ↓MMD
Field Length: 8
Format: Numeric
Description: An MMIS Provider ID is a unique identification number assigned to a provider by NYS Medicaid when
the provider enrolls in NYS Medicaid. The MCP MMIS Provider ID, also referred to as the Plan ID, is the MMIS
Provider ID associated with the member’s Managed Care Plan (same as Managed Care Organization MMIS ID).
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Editing Logic: For fee for service members, this field will be blank. For all files, except for the Billing Support
Download file, the value included in the Managed Care Plan MMIS Provider ID field is associated with the
member’s current MCP. On the Billing Support Download file, this field is populated with the MCP that the
member was associated with as of the billing instance service date.
MCP Name ↓BSD ↓CD ↓HHA ↓MA ↓MMD ↓PRD
Field Length: 40
Format: Alphanumeric
Description: The name associated with the Managed Care Plan MMIS Provider ID within NYS Medicaid MDW. For
fee for service members, this field will be blank.
MCP Assignment Created Date ↓HHA ↓MA
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a member assignment began in the pending status with an MCP. If an MCP assignment
started in the active status, the MCP Assignment Created Date will match the MCP Assignment Start Date (same
as MCP Assignment Create Date).
MCP Assignment Record Type ↓HHA ↓MA
Field Length: 10
Format: Alpha (Assignment, Referral)
Description: This field is utilized to identify the different types of MCP assignments in the system: Assignment,
meaning the member was assigned to the plan by DOH and, Referral, which means that the member assignment
resulted from a community referral. This field is used to indicate the record’s MCP assignment type.
MCP Assignment Start Date ↓MA↓HHA
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date the MCP Assignment was accepted.
MCP Determined Eligibility ↓HHA ↓MA ↑MFA
Field Length: 23
Format: Numeric Accepted Values Appendix K: MCP Final HH Assignment File Accepted Values Description: Allows up to 8 2-digit coded eligibility reasons to be uploaded or displayed with a space delimiter.
MCP Type ↓BSD ↓HHA
Field Length: 40 (↓HHA), 10 (↓BSD)
Format: Alpha
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Description: This field indicates the provider type of the MCP as it is stored in the Provider Management section in
the profile of the organization in the system. When there is more than one provider type listed for an MCP within
the category of MCP, this field will be blank.
MDW Member Address 1/ Address 2 ↓HHA ↓MA ↓MMD
Field Length: 40
Format: Alphanumeric
Description: The most recent NYS Medicaid member contact information from NYS Medicaid’s Medicaid Data
Warehouse. If this information is incorrect, work with the member to correct this information with NYS Medicaid.
For more information on how to change member Medicaid information, please see Appendix L: Reference and
Contacts (same as DOH MDW Address 1/2 and MDW Member Address Line 1/Line 2).
Medicaid Coverage Code ↓CD
Field Length: 2
Format: Alphanumeric
Description: A 2-digit code that describes what types of services a Medicaid member is eligible to receive. Please
see the link below for additional information on coverage codes’ compatibility with the Health Home program:
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/hh_coverage_codes.pd
f
Medicaid Coverage Code Description ↓CD
Field Length: 40
Format: Alpha
Description: Describes the 2-digit Medicaid Coverage Code.
Medicaid Effective Date ↓CD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date that a member’s most recent Medicaid eligibility became effective.
Medicaid Eligibility End Date ↓CD↓ED ↓HHA ↓MA ↓MMD
Field Length: 8
Format: MMDDYYYY, Numeric Description: Indicates when a member’s Medicaid eligibility ends. This field is populated with a member’s most current NYS Medicaid eligibility end date. If a member’s Medicaid Eligibility End Date is in the past that indicates that the member was Medicaid eligible prior to that end date, but that the member is not currently eligible. If the member does not have a value in the Medicaid Eligibility End Date field that means that the member has a Medicaid Eligibility End Date of 12/31/9999 (the system will not display 12/31/9999 to indicate that a member is indefinitely eligible). Please note: it may take up to a week for information corrected or updated in NYS Medicaid’s MDW to be listed within the MAPP HHTS.
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Medicaid Eligibility Status ↓BSD
Field Length: 1
Format: Alpha (Y/N)
Description: This field indicates whether or not a member is Medicaid eligible as of the billing instance service
date. A value of ‘Y’ means that the member is Medicaid eligible as of the billing instance service date and a value
of ‘N’ means that the member is not Medicaid eligible as of the billing instance service date. Please note: it may
take up to a week for a recently updated member eligibility status to be listed within the MAPP HHTS.
Medicaid Recipient Exemption Code 1-5 ↓CD
Field Length: 2
Format: Alphanumeric
Description: Exception Codes are two-character codes that identify a member’s Medicaid program exceptions or
restrictions. Please see the link below for additional information on recipient exemption codes’ compatibility with
the Health Home program.
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/restriction_exception_
codes.pdf
Medicaid Recipient Exemption Code 6 to 16 ↓CD
Field Length: 32
Format: Alphanumeric (space deliminated)
Description: Up to 11 additional 2-digit RE codes will be displayed in this field with a space between each RE code.
These are the 6th through 16th most recent RE codes based on start date in NYS Medicaid.
Medicaid Recipient Exemption Code Description 1-5 ↓CD
Field Length: 40
Format: Alpha
Description: Describes the 2-digit
Medical Services Provider ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that provide medical care.
Medicare Indicator ↓HHA ↓MA
Field Length: 1
Format: Alpha (N/Y)
Description: A value of ‘Y’ in this filed indicates that the member is enrolled in Medicare. A value of ‘N’ indicates that a member is not enrolled in Medicare.
Member Address Line 1/ Address Line 2 ↓MMD↓HHA ↓MA
Field Length: 40
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Format: Alphanumeric
Description: The most recent NYS Medicaid member contact information from NYS Medicaid’s Medicaid Data Warehouse. If this information is incorrect, then the member must update the information with NYS Medicaid. Please see Appendix L: Reference and Contacts for information on how a member can update this information with NYS Medicaid (same as DOH MDW Address 1, DOH MDW Address 2, MDW Member Address 1, Address1/2 and MDW Member Address 2). Please note: it may take up to a week for information corrected in NYS Medicaid’s MDW to be listed within the MAPP HHTS.
Member Age ↓CD ↓MMD
Field Length: 3
Format: Numeric
Description: The age of the member in years.
Member City ↓HHA ↓MA ↓MMD
Field Length: 40
Format: Alphanumeric
Description: The most recent member contact information from NYS Medicaid’s MDW. If this information is incorrect, then the member must update the information with NYS Medicaid. Please see Appendix L: Reference and Contacts for information on how a member can update this information with NYS Medicaid. (same as MDW Member City and City). Please note: it may take up to a week for information corrected in NYS Medicaid’s MDW to be listed within the MAPP HHTS.
Member Fiscal County Code ↓BSD
Field Length: 2
Format: Numeric
Description: This field is populated with the most recent member information available from NYS Medicaid. If the
NYS Medicaid information is incorrect, then the member must update the information with NYS Medicaid. Please
see Appendix L: Reference and Contacts for information on how a member can update this information with NYS
Medicaid. Please note: it may take up to a week for information corrected in NYS Medicaid’s MDW to be listed
within the MAPP HHTS.
Member Fiscal County Code Description ↓BSD
Field Length: 40
Format: Alphanumeric
Description: This describes the county that is associated with a member’s county code.
Member Housed ↑BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N) Description: Currently this field should be left blank on the upload file. This field is obsolete and has been nulled out on the download file.
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Member Housing Status/Member Living Status ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: This field is submitted on the Billing Support Upload file to indicate if a member is homeless, as
defined by HUD categories 1 and 2. A value of ‘Y’ means that the member is homeless, and a value of ‘N’ means
that the member is not homeless.
Member ID/CIN ALL FILES EXCEPT PROVIDER FILES
Field Length: 8
Format: AA111111A, Alphanumeric
Description: This is a unique NYS Medicaid number used to identify Medicaid members. Please note: it may take
up to a week for information recently updated with NYS Medicaid to be available within the MAPP HHTS. For
example, if may take up to a week for the MAPP HHTS to recognize the CIN of a newly enrolled Medicaid member.
Editing Logic: This field must be populated with a valid member ID.
Member Phone ↓HHA ↓MA ↓MMD
Field Length: 10
Format: Numeric
Description: The most recent member contact information from NYS Medicaid’s MDW. If this information is
incorrect, then the member must update the information with NYS Medicaid. Please see Appendix L: Reference
and Contacts for information on how a member can update this information with NYS Medicaid. (same as MDW
Member Phone and Phone)
Member State ↓HHA ↓MA ↓MMD
Field Length: 2
Format: Alpha
Description: The most recent member contact information from NYS Medicaid’s MDW. If this information is
incorrect, then the member must update the information with NYS Medicaid. Please see Appendix L: Reference
and Contacts for information on how a member can update this information with NYS Medicaid. (same as MDW
Member State and State).
Member Zip Code ↓BSD ↓ HHA↓ MA ↓ MMD
Field Length: 9
Format: Numeric
Description: This field is populated with the most recent member information available from NYS Medicaid. If the
NYS Medicaid information is incorrect, then the member must update the information with NYS Medicaid. Please
see Appendix L: Reference and Contacts for information on how a member can update this information with NYS
Medicaid. Please note: it may take up to a week for information corrected in NYS Medicaid’s MDW to be listed
within the MAPP HHTS (same as MDW Member Zip Code and DOH MDW Member Zip Code and Zip).
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Mental Illness or Physical Health Inpatient Stay ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N/U/M/P/N/V) Accepted Values See Appendix H: High, Medium, Low (HML) Assessment Codes
Description: Indicates if a member has had an inpatient stay for either Mental Illness or Physical Health within the
last year.
Mental Illness or Physical Health Inpatient Discharge Date ↓BSD ↑BSU
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field must be populated if the Mental Illness indicated that the member had an inpatient stay for
either mental health or physical health within the last year. This field is part of the High, Medium, Low (HML)
Assessment and is one of the variables used to determine a member’s monthly HML rate (same as Mental Illness
Discharge Date).
Editing Logic: If Mental Illness (field #14) of the Billing Support Upload file contains a value of that indicates that
the member did have an inpatient stay for Mental or Physical Health then this field must be populated. If Mental
Illness (field #14) of the Billing Support Upload file contains a value of ‘N’ or ‘U’, then this field should be blank and
the system will ignore any values submitted in Mental Illness Stay Discharge Date (field #15). If a provider knows
that a member was recently discharged from an inpatient stay due to mental illness or physical health, but does
not know the members’ discharge date, then Mental Illness (field #14) must be populated with a value of ‘U’ or ‘V’
and Mental Illness Stay Discharge Date (field #15) should be blank.
Month Submitted ↓BSD
Field Length: 1
Format: Alphanumeric
Description: This field represents the month of the HML, 1-6. A 1 will always be displayed for outreach segments,
Children’s Billing Questionnaires and CANs-NY Assessment Fees.
Name Associated with Partner NPI per NYS Medicaid ↓PND
Field Length: 70
Format: Alpha Description: The name that is associated with the NPI the Health Home uploaded on the Partner Network Upload File per NYS Medicaid.
New Start Date ↓CE ↑CU
Field Length: 8
Format: Numeric, MMDDYYYY
Description: The start date of the newly uploaded consent record.
No of outreach mos within 12 mos ↓HHA ↓ MA
Field Length: 2
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Format: Numeric (01-12)
Description: This field displays the count of the number of months of outreach in a status other than Cancelled or
Hiatus for a member within the last 12 months.
NYSID ↑TFS↓ED
Field Length: 9
Format: Alphanumeric
Description: The New York State Identification Number is a unique identifier assigned to an individual by the New
York State Division of Criminal Justice Services. This is an optional field.
OASAS Services ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that provide Alcohol and/or Substance Abuse services and/or any other services regulated by
the Office Alcohol and Substance Abuse.
OMH Services ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that provide Mental Health/Behavior Health services and/or any other services regulated by
the Office of Mental Health.
Opt-Out Effective Date ↓PP ↓CN↓PAD Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field is system populated with the date the opt-out is effective in the MAPP HHTS. This date is
the first of the month following the Opt-Out Signature Date.
Opt-Out End Date ↓PAD ↓PP ↑PU ↓CN Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field is populated with the date the member ends their opt out and is submitted by the user on
the Program Participation upload file.
Opt-Out Reason ↓PP ↑PU
Field Length: 2
Format: Numeric Accepted Values: see Appendix N: Program Participation File Codes
Description: This field is populated with the reason code describing a members opt-out. This code is submitted by the provider who secured the opt-out signature.
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Opt-Out Reason Description ↓PP
Field Length: 50
Format: Alphanumeric
Description: The description of the Opt-Out Reason
Opt-Out Signature Date ↓PAD ↓PP ↑PU ↓CD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field is populated with the date the opt-out of Health Homes form is signed.
Opt-Out Submission Date ↓PP ↓CD ↓PAD Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field is system populated with the date the opt-out was submitted to the MAPP HHTS.
Opt-Out Submitted by Organization Name ↓PAD ↓PP ↓CD Field Length: 40
Format: Alphanumeric, Alpha (CD)
Description: This field is system populated with the provider organization that submitted the opt-out information.
Opt-Out Submitted by User ↓CD
Field Length: 40
Format: Alpha
Description: This field is system populated with the first and last name of the user who submitted opt-out
information about the member.
OPWDD Services ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that provide services to People with Developmental Disabilities and/or any other services
regulated by the Office for People with Developmental Disabilities.
Original Record from File ↓PNE ↓BSE
Field Length: 140 (BSE), 137 (PNE)
Format: Alphanumeric
Description: This field is populated with a concatenation of the all the field values on the originally submitted
record that was rejected.
Originating Referral Source Area Code ↓CRD
Field Length: 3
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Format: Numeric or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the first three digits of the phone number of the provider or the organization that
originally identified the member as HH eligible and made the referral to the provider entering the referral into the
MAPP HHTS.
Originating Referral Source City ↓CRD
Field Length: 30
Format: Alpha or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the name of the city pertaining to the address of the provider or the organization
that originally identified the member as HH eligible and made the referral to the provider entering the referral into
the MAPP HHTS.
Originating Referral Source Contact Name ↓CRD
Field Length: 60
Format: Alpha or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the name of the provider who originally identified the member as HH eligible and
made the referral to the provider entering the referral into the MAPP HHTS.
Originating Referral Source Extension ↓CRD
Field Length: 5
Format: Alphanumeric or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
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Description: This field can include the extension number that accompanies a phone number of the provider or the
organization that originally identified the member as HH eligible and made the referral to the provider entering the
referral into the MAPP HHTS.
Originating Referral Source Organization ↓CRD
Field Length: 30
Format: Alphanumeric or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the name of the entity/organization of the provider who originally identified the
member as HH eligible and made the referral to the provider entering the referral into the MAPP HHTS.
Originating Referral Source Phone Number ↓CRD
Field Length: 7
Format: Numeric or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the seven digits (after the area code) of the phone number of the provider or the
organization that originally identified the member as HH eligible and made the referral to the provider entering the
referral into the MAPP HHTS.
Originating Referral Source Phone Type ↓CRD
Field Length: 3
Format: Alpha or Blank Accepted values: Home, Cell, Work
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the type of phone the provider that originally identified the member as HH eligible
and made the referral to the provider entering the referral into the MAPP HHTS is utilizing. This should describe
the type of phone associated with the provided Originating Referral Source Phone Number.
Originating Referral Source State ↓CRD
Field Length: 2
Format: Alpha or Blank
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Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the abbreviated name of the state pertaining to the address of the provider or the
organization that originally identified the member as HH eligible and made the referral to the provider entering the
referral into the MAPP HHTS.
Originating Referral Source Street 1 ↓CRD
Field Length: 30
Format: Alphanumeric or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the street address of the provider or the organization that originally identified the
member as HH eligible and made the referral to the provider entering the referral into the MAPP HHTS.
Originating Referral Source Street 2 ↓CRD
Field Length: 30
Format: Alphanumeric or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
Description: This field includes the continuation of the street address of the provider or the organization that
originally identified the member as HH eligible and made the referral to the provider entering the referral into the
MAPP HHTS.
Originating Referral Source Zip Code ↓CRD
Field Length: 9
Format: Numeric or Blank
Editing Logic: This field will be populated with information only if the provider entering a children’s referral
through the CRP has indicated that someone outside of their organization provided them with the referral
information outside of the MAPP HHTS. The system will populate this field with the information the MAPP HHTS
user enters while completing the child referral for the originating referrer.
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Description: This field includes the zip code number pertaining to the street address of the provider or the
organization that originally identified the member as HH eligible and made the referral to the provider entering the
referral into the MAPP HHTS.
Other ↓MAD
Field Length: 60
Format: Alpha
Description: For MCP users, this field will be populated with the DOH recommended Heath Home assignment. For
all other users, this field will be blank.
OT/PT/Speech ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that provide OT (Occupational Therapy), PT (Physical Therapy), and/or Speech Therapy
services.
Outpatient Score ↓HHA ↓MA
Field Length: 6
Format: Decimal, 999V99
Description: This field is obsolete and has been nulled out on the Health Home Assignment File and Managed Care
Plan Assignment File.
Outreach/Enrollment Code ↓BSD ↓ED ↓HHA ↓MA ↑TFS
Field Length: 1
Format: Alpha (O/E/F)
Description: Specifies whether the segment is outreach ‘O’ or enrollment ‘E’. If both outreach and enrollment
occurred in the same month, then the member should have an enrollment segment for that month. On the Billing
Support Download file only the Billing Instance Type may also include F to indicate that an initial CANs-NY
Assessment Fee can be billed for the service date (same as Segment Type and Billing Instance Type).
Paid Claim Provider ID ↓BSD
Field Length: 8
Format: Numeric
Description: This field is populated if the system determines that there is a NYS Medicaid claim or encounter
associated with the member’s added billing instance service date. Please see the Billing Support Download File:
Description section for an explanation of how the system identifies a claim or encounter that is associated with a
member’s added billing instance service date.
An MMIS Provider ID is a unique identification number assigned to a provider by NYS Medicaid upon enrollment
into NYS Medicaid. This field indicates the MMIS Provider ID on the claim or encounter associated with the
member’s added billing instance service date. Although this field name includes the word “Paid,” this field will
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always be populated when there is a NYS Medicaid claim associated with the member’s billing instance service
date, whether the claim was paid, voided, or denied.
Please note: Encounters take longer to be submitted to DOH and therefore there can be a delay in this information
populating in the MAPP HHTS system.
Paid Claim Provider ID equals MAPP Billed Entity MMIS ID ↓BSD
Field Length: 1
Format: Alpha (Y/N)
Description: This field is populated if the system determines that there is a NYS Medicaid claim or encounter
associated with the member’s added billing instance service date. Please see the Billing Support Download File:
Description section for an explanation of how the system identifies a claim or encounter that is associated with a
member’s added billing instance service date.
If the MMIS Provider ID in the Paid Claim Provider ID (field #64) matches the MMIS Provider ID in the Billing Entity
MMIS ID (field #20), then this field will be populated with a value of ‘Y’. If the MMIS Provider ID in the Paid Claim
Provider ID (field #64) does not match the MMIS Provider ID in the Billing Entity MMIS ID (field #20), then this
field will be populated with a value of ‘N’. Although this field name includes the word “Paid,” this field will always
be populated when there is a NYS Medicaid claim or encounter associated with the added billing instance service
date, whether the claim or encounter was paid, voided, or denied.
Please note: Encounters take longer to be submitted to DOH and therefore there can be a delay in this information
populating in the MAPP HHTS system.
Paid Claim Provider Name ↓BSD
Field Length: 40
Format: Alphanumeric
Description: This field is populated if the system determines that there is a NYS Medicaid claim or encounter
associated with the member’s added billing instance service date. Please see the Billing Support Download File:
Description section for an explanation of how the system identifies a claim or encounter that is associated with a
member’s added billing instance service date.
This is the NYS Medicaid name associated with the MMIS Provider ID listed in the Paid Claim Provider ID (field
#64). Although this field name includes the word “Paid,” this field will always be populated when there is a NYS
Medicaid claim or encounter associated with the member’s billing instance service date, whether the claim or
encounter was paid or denied.
Please note: Encounters take longer to be submitted to DOH and therefore there can be a delay in this information
populating in the MAPP HHTS system.
Paid Claim Rate Code ↓BSD
Field Length: 4
Format: Numeric
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Description: This field is populated if the system determines that there is a NYS Medicaid claim or encounter
associated with the member’s added billing instance service date. Please see the Billing Support Download File:
Description section for an explanation of how the system identifies a claim or encounter that is associated with a
member’s added billing instance service date.
This field indicates the rate code on the claim associated with the record’s member and service date. Although this
field name includes the word “Paid,” this field will always be populated when there is a NYS Medicaid claim or
encounter associated with the member’s added billing instance service date, whether the claim or encounter was
paid or denied.
Please note: Encounters take longer to be submitted to DOH and therefore there can be a delay in this information
populating in the MAPP HHTS system.
Paid Claim Rate Code equals MAPP HML Rate Code ↓BSD
Field Length: 1
Format: Alpha (Y/N)
Description: This field is populated if the system determines that there is a NYS Medicaid claim or encounter
associated with the member’s added billing instance service date. Please see the Billing Support Download File:
Description section for an explanation of how the system identifies a claim or encounter that is associated with a
member’s added billing instance service date.
If the rate code in the Paid Claim Rate Code (field #66) matches the rate code in the Rate Code (field #54), then
this field will be populated with a value of ‘Y’. If the rate code in the Paid Claim Rate Code (field #66) does not
match the rate code in the Rate Code (field #54), then this field will be populated with a value of ‘N’. Although this
field name includes the word “Paid,” this field will always be populated when there is a NYS Medicaid claim or
encounter associated with the member’s added billing instance service date, whether the that claim or encounter
was paid or denied.
Please note: Encounters take longer to be submitted to DOH and therefore there can be a delay in this information
populating in the MAPP HHTS system.
Partner NPI ↓PND ↑PNU
Field Length: 10
Format: Numeric
Description: The NPI that is associated with the provider or provider group in MDW. The submitted NPI field must
either contain 10 numeric characters or be null, otherwise the record will be rejected.
Payment Cycle ↓BSD
Field Length: 4
Format: Numeric
Description: This field is populated if the system determines that there is a NYS Medicaid claim or encounter
associated with the member’s added billing instance service date. Please see the Billing Support Download File:
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Description section for an explanation of how the system identifies a claim that is associated with a member’s
added billing instance service date.
The Payment Cycle (field #59) in the Billing Support Download file is a four-digit number that corresponds to a
specific NYS Medicaid claims or encounter processing period. For more information on this cycle number, please
see the eMedNY and payment cycle calendar links available in Appendix: L Reference and Contacts.
Please note: Encounters take longer to be submitted to DOH and therefore there can be a delay in this information
populating in the MAPP HHTS system.
Payor ↓BSD
Field Length: 1
Format: Alpha (P/F/Blank)
Description: If a member is in a mainstream plan, this field will be populated with P, otherwise it will be populated
with a F.
Pediatric Provider ↓PND ↑PNU
Field Length: 1
Format: Alpha (N/Y)
Description: Partners that provider services to children.
Pend/End Reason Comments ↓ED↑TFS
Field Length: 300 (ED), 40 (TFS)
Format: Alphanumeric
Description: This field includes any comments associated with a pended or ended segment that the user provided
when pending/ending the segment. If a segment contains both pend and end reason comments, the segment’s
end reason comment will be displayed in this field (same as Pend Reason Code Comment and Pend Reason or
Segment End Date Reason Comments).
Pending Referral ↓MMD
Field Length: 1
Format: Alpha (Y/N)
Description: This field will be populated with a Y if the member record is a pending referral
Description: This field will be populated with a Y if the member record is a pending referral
Pend Reason Code Comment ↓HHA ↓MA
Field Length: 300
Format: Alphanumeric
Formatted: Underline
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Description: The data in this field would be manually entered by an MCP provider to further describe the reason
\why an assignment was pended. This field is required if the Pend reason is “Other”. The contents of this field
display on the MCP Assignment File when entered for all pend reasons.
Pend Reason Code Comment ↓MA ↓HHA Field Length: 300
Format: Alphanumeric Description: The data in this field is entered by an MCP user to provider additional information as to why an assignment was pended. This field is required if the Pend Reason Code is ‘Other’, but the field will be populated with any submitted comment regardless of the Pend Reason Code.
Pend Reason Code Description ↓MMD
↓BSD Field Length: 40
Format: Alphanumeric Description: Describes the Pend reason that corresponds to the Pend Reason Code.
Pend Reason Code/Segment Pend Reason Code ↓BSD ↓HHA ↓MA ↓EFA ↑MFA ↑TFS ↓ED
Field Length: 2
Format: Alphanumeric, Numeric (MA) Accepted Values: Appendix C for pending a segment and Appendix F for pending an Assignment
Description: The value in the Pend Reason Code (field #3) on the MCP Final HH Assignment file and the Error
Report: MCP Final HH Assignment, the Health Home Assignment and the Managed Care Plan Assignment files
represents the reason that an MCP pended an assignment.
The value in the Pend Reason Code (field #11) on the Billing Support Download file and the Tracking File Segment
Records and the Segment Pend Reason Code (field #18) on the Enrollment Download file represents the reason
that HH or CMA pended an outreach of enrollment segment.
Pend Start Date ↑TFS
Field Length: 8
Format: Numeric, MMDDYYYY
Description: The start date of the pended segment
Physician Indicator ↓PND ↑PNU
Field Length: 1
Format: Alpha (Y/N)
Description: A value of Y indicates that the partner is an individual practitioner or a practitioner group. A value of
N indicates that the partner is not an individual (the partner is a member of a facility).
Formatted: Font: (Default) +Body (Calibri), 10 pt, Bold,Font color: Black
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Pioneer ACO ↓MMD
Field Length: 1
Format: Alpha (Y/N)
Description: Indicates whether a member is part of the Pioneer ACO population.
Plan of Care Create Date ↓CF
Field Length: 8
Format: MMDDYYYY, Numeric
Description: A system generated date that reflects when the plan of care date was submitted to the system.
Plan of Care Date ↑CU↓CF
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field contains the date that plan of care is signed as submitted to the system by the HH (same as Plan of Care). Editing Logic: Only Health Homes can submit a Plan of Care Date.
Plan of Care HH MMIS Provider ID ↓CF Field Length: 8 Format: Numeric Description: The HH MMIS ID that is associated with the Plan of Care information
Plan of Care HH Name ↓CF Field Length: 40 Format: Alpha Description: The HH name that is associated with the Plan of Care information.
Plan Provided Member Language ↓HHA ↓MA ↑MFA ↓MMD
Field Length: 30; 40(MMD)
Format: Alpha
Description: Member information submitted to the system on the Managed Care Final HH Assignment file by the
member’s MCP. If the MCP did not submit this information into the system on the Managed Care Final HH
Assignment file, then this field will be blank on the Managed Care Assignment file and the Health Home
Assignment file (same as Language).
Plan Provided Member Phone Number ↓HHA ↓MA ↑MFA
Field Length: 10
Format: Numeric
Description: Member information submitted to the system on the Managed Care Final HH Assignment file by the
member’s MCP. If the MCP did not submit this information into the system on the Managed Care Final HH
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Assignment file, then this field will be blank on the Managed Care Assignment file and the Health Home
Assignment file.
Plan Provided Secondary Address – Apt/Suite ↓HHA ↓MA ↑MFA
Field Length: 20
Format: Alphanumeric
Description: Member information submitted to the system on the Managed Care Final HH Assignment file by the
member’s MCP. If the MCP did not submit this information into the system on the Managed Care Final HH
Assignment file, then this field will be blank on the Managed Care Assignment file and the Health Home
Assignment file.
Plan Provided Secondary Address – City ↓HHA ↓MA ↑MFA
Field Length: 40
Format: Alpha
Description: Member information submitted to the system on the Managed Care Final HH Assignment file by the
member’s MCP. If the MCP did not submit this information into the system on the Managed Care Final HH
Assignment file, then this field will be blank on the Managed Care Assignment file and the Health Home
Assignment file.
Plan Provided Secondary Address – State ↓HHA ↓MA ↑MFA
Field Length: 2
Format: Alpha
Description: Member information submitted to the system on the Managed Care Final HH Assignment file by the
member’s MCP. If the MCP did not submit this information into the system on the Managed Care Final HH
Assignment file, then this field will be blank on the Managed Care Assignment file and the Health Home
Assignment file.
Plan Provided Secondary Address – Street 1 & Street 2 ↓HHA ↓MA ↑MFA
Field Length: 40
Format: Alphanumeric
Description: Member information submitted to the system on the Managed Care Final HH Assignment file by the
member’s MCP. If the MCP did not submit this information into the system on the Managed Care Final HH
Assignment file, then this field will be blank on the Managed Care Assignment file and the Health Home
Assignment file.
Plan Provided Secondary Address – Zip ↓HHA ↓MA ↑MFA
Field Length: 9
Format: Numeric
Description: Member information submitted to the system on the Managed Care Final HH Assignment file by the
member’s MCP. If the MCP did not submit this information into the system on the Managed Care Final HH
Assignment file, then this field will be blank on the Managed Care Assignment file and the Health Home
Assignment file.
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Pre-Conditions of member ↓BSD ↑BSU
Field Length: 16
Format: Numeric
Accepted Values: Please see Appendix H: High, Medium, Low (HML) Assessment
Description: A provider must indicate the chronic condition(s) that qualify a member for enrollment in the Health
Home program. Please refer to the provider manual link available in Appendix L) for more information on the
chronic conditions that qualify a member for Health Home services.
Editing Logic: List all codes that explain why the member is Health Home eligible. Do not separate out codes with
commas, spaces, or any other delimiter. For example, if a member’s Diabetes and Heart Disease makes the
member Health Home eligible, then this field should be populated with the diabetes code (08), the heart disease
code (10) and 12 blank spaces: ‘0810 ‘. If code 16 ‘Other’ is submitted within this field, then field Description of
“Other” pre-condition is required.
A member’s pre-conditions(s) must be submitted on the Billing Support Upload file in Pre-Conditions of member
(field # 5). This is a required field and must be populated for all service dates that correspond with an enrollment
segment.
Program Participation ↓CD Field Length: 7
Format: Alpha
Description: This field is populated with opt-out if the member has an opt-out record with a start and end date
that falls within the time period that the CIN Search file is downloaded.
Provided Service Indicator ↓ED↓BSD↑TSF
Field Length: 1
Format: Alpha (A/C)
Description: This field is populated based on whether the member is in an Adult or Child HH network type on the
associated segment (same as Adult or Child Services Provided Indicator).
Rate Amount ↓BSD
Field Length: 7
Format: Numeric, "0000.00"
Description: This is the rate amount associated with the rate code for the billing instance service date. This field
will only be populated when a billing questionnaire has been successfully submitted.
Rate Code ↓BSD
Field Length: 4
Format: Numeric
Description: This is the rate code that the responsible biller must use to bill Medicaid for the Health Home services
provided to the member for the billing instance service date. The system may use the High, Medium, Low logic or
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CANS acuity as well as other system generated logic to determine the appropriate rate code for a member’s billing
instance service date.
Rate Code Description ↓BSD
Field Length: 30
Format: Alphanumeric
Description: This field is populated differently depending on the billing instance service date. Please see Editing
Logic below for more information.
Editing Logic:
For billing instance service dates on or after 12/1/16, this field describes the rate code that a member should be
billed under for the billing instance service date.
Reason ↓PRD
Field Length: 40
Format: Alphanumeric
Description: Reasons are carried over from the Provider Relationship Management Screen.
Recent Care Management Biller 1-6 Provider ID ↓CD
Field Length: 8
Format: Numeric
Description: Based on Claims and Encounters data these fields are populated with the most recent paid claims or
encounters information that have been submitted to NYS Medicaid.
Recent Care Management Biller 1-6 Service Date ↓CD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: Based on Claims and Encounters data these fields are populated with the most recent paid claims or
encounters information that have been submitted to NYS Medicaid.
Recent Care Manager Biller 1-6 Provider Name ↓CD
Field Length: 40
Format: Alpha
Description: Based on Claims and Encounters data these fields are populated with the most recent paid claims or
encounters information that have been submitted to NYS Medicaid.
Record Type ↑TFS ↑TFE ↑TFD ↑TFA ↓MAD ↑PU ↑CU ↓CE
Field Length: 1 (all files except MAD); 10 (MAD only)
Format: Alpha
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Accepted Values: S, R, E, N, C, A, M, P, D (all except MAD); Assignment and Referral
Please also see Appendix I: Record Type Codes for more information
Description (all files except MAD): Defines the type of record that is being submitted to the system: Accept
Assignment (S), Reject (R), End (E), New (N), Create (C), Accept Segment (A), Modify (M), Pend (P) and Delete (D).
The system will process the record based on the layout defined for the record type.
Description (MAD Only): In the system, assignments have record types that are used to identify the different types
of assignments: Assignment, meaning the member was assigned to a downstream provider; Referral, which means
that the member assignment resulted from a community referral; and Transfer, which means that the member’s
current HH is asking if the receiving provider will accept the member as a Transfer or another HH is asking the
current HH to transfer the member to them. The Record Type (field #4) on the on the Manage Assignments
Download file is used to indicate the record’s assignment type.
Referral Code ↓ED ↑TFS
Field Length: 1
Format: Alpha
Accepted Values: R/T, Blank
Description: The Referral Code indicates if a Medicaid member is a new referral ‘R’. A ‘T’ can be used to accept a
pending transfer for an adult (21 and over). If the member is not a new referral or transfer member the field
should be blank.
Editing Logic: If the member is not a referral/transfer, then Health Home ID must match the assigned values for the
Medicaid member. On the TFS, a provider can only use an ‘R/T’ code to create a segment for members that are 21
years or older. Child members must have a pending or active assignment with the uploading provider for a
segment to be created via the file.
Referral HH MMIS Provider ID ↓MMD
Field Length: 8
Format: Numeric
Description: The MMIS ID of the provider making the referral.
Referral Suggested Health Home Assignment/Referral Suggested Assignment ↓MA ↓MMD
Field Length: 8
Format: Numeric
Description: This field displays the MMIS ID of a Health Home if that Health Home is suggested during the referral
process.
Referrer First Name ↓CRD
Field Length: 30
Format: Alpha
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Description: This field includes the first name of the user (referrer) that submitted the most recent referral for the
member via the Children’s Referral Portal.
Referrer Last Name ↓CRD
Field Length: 30
Format: Alpha
Description: This field includes the last name of the user (referrer) that submitted the most recent referral for the
member via the Children’s Referral Portal.
Referrer Organization ID ↓CRD
Field Length: 8
Format: Numeric
Description: This field includes the MMIS ID or HCS ID of the organization that submitted the most recent referral
for the member via the Children’s Referral Portal. If DOH submitted the referral, the MMIS ID or HCS ID of the
organization that DOH submitted the referral on behalf of be included in this field.
Referrer Organization Name/ Referral HH Name ↓MMD ↓CRD
Field Length: 30 (CRD), 40 (MMD)
Format: Alphanumeric
Description: This field includes the MCP program name, HH program name, CMA program name, LGU Organization
name, LDSS organization name, or SPOA organization name of the organization that submitted the most recent
referral via the Children’s Referral Portal/Adult Referral Wizard. If DOH submitted the referral, the name of the
organization that DOH submitted the referral on behalf of be included in this field.
Rejected Assignment Suggested HH Assignment ↓HHA↓MMD
Field Length: 8
Format: Numeric (MMIS ID or blank)
Description: This field is used to indicate a suggested assignment when one is rejected.
Rejection Reason Code ↓HHA↓MA ↑TFA
Field Length: 2
Format: Numeric
Accepted Values: See Appendix E: Assignment Rejection Reason Codes
Description: This field is used to indicate why a provider is rejecting an assignment (same as Rejection Reason).
Rejection Reason Comment ↑TFA ↓MA↓HHA
Field Length: 40 (TFA), 300 (MA)
Format: Alphanumeric
Description: This field is mandatory when a provider rejects an assignment using assignment rejection reason code
09: Other. When an assignment is rejected using rejection reason code 09, the provider must use this field to
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describe their reason for rejecting the assignment. A provider may submit a comment in this field if they select a
different Rejection Reason Code.
Residence ↓PND ↑PNU
Field Length: 1
Format: Alpha (Y/N)
Description: Partners that run residential programs.
Risk ↓BSD ↓HHA ↓MA
Field Length: 6
Format: Decimal, 999V99
Description: This field is obsolete and has been nulled out on the Assignment Files. This value is nulled out on the
Health Home Assignment File and Managed Care Plan Assignment File and Billing Support Download File.
Segment End Date ↓HHA ↓MA
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The end date indicates when a value or a status becomes no longer effective.
Editing Logic: This field must contain a valid date. The end date must always be the last day of the month. For
example, if the services ended on May 10, 2016, the End Date must be 5/31/16. This date may not fall within an
existing service segment.
The Segment End Date indicates when the segment ended. When a member dis-enrolls from Health Home
services, the end date will indicate when Health Home services were discontinued. When a member is moving
from outreach and engagement to enrollment, an end date is not needed to end date the outreach segment.
When a create record for enrollment is submitted to DOH, the system will automatically end date any outreach
segments that are open under the primary key as of the submitted end date.
Segment End Date Description ↓ED ↓HHA ↓MA
Field Length: 40
Format: Alpha Accepted Values: See Appendix D: Segment End Date Reason Codes
Description: The reason why the segment is being end dated. This field is blank if the segment is open (same as
Segment End Date Reason Description).
Segment End Date Reason Comment ↑TFS ↓MA ↓HHA
Field Length: 300 (MA/HHA), 40 (TFS)
Format: Alpha/Alphanumeric
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Description: A free text field to add or display the comment that is included when ending a segment (same as
Segment End Date Reason Comments).
Segment Pend Reason Description/Pend Reason ↓MMD ↓ED
Field Length: 40
Format: Alpha, Alphanumeric (MMD) Accepted Values: See Appendix C: Segment Pend Reason Codes
Description: The reason why the segment is being pended. This field is left blank if the segment is in a status other
than pended.
Segment Status ↓CD ↓MMD Field Length: 40 (CD); 20 (MMD)
Format: Alpha Description: The status of the segment that the member is in. If there is no segment this field will be blank.
Segment Type ↓CD ↓MMD
Field Length: 1
Format: Alpha (O/E) Description: (same as Outreach/Enrollment Code)
Service 1-5: Last Service Address Line 1/Address Line 2 ↓CD ↓HHA ↓MA
Field Length: 40
Format: Alphanumeric
Description: The contact information for the most recent service submitted to Medicaid for the Medicaid member
(same as Provider 1-5 Address 1/Address 2).
Service 1-5: Last Service City ↓CD ↓HHA ↓MA
Field Length: 40
Format: Alphanumeric, Alpha (CD)
Description: The contact information for the most recent service submitted to Medicaid for the Medicaid member
(same as Provider I-5 City).
Service 1-5: Last Service Date ↓CD ↓HHA ↓MA
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The date of the most recent service submitted to Medicaid for the Medicaid member (same as
Provider 1-5 Service Date).
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Service 1-5: Last Service Phone Number ↓CD ↓HHA ↓MA
Field Length: 10
Format: Numeric
Description: The contact information for the most recent service submitted to Medicaid for the Medicaid member
(Same as Provider 1-5 Phone).
Service 1-5: Last Service Provider Name ↓CD ↓HHA ↓MA
Field Length: 40
Format: Alpha
Description: The contact information for the most recent service submitted to Medicaid for the Medicaid member
(same as Provider 1-5 Provider Name).
Service 1-5: Last Service Provider NPI ↓HHA ↓MA
Field Length: 10
Format: Numeric
Description: The contact information for the most recent service submitted to Medicaid for the Medicaid member.
Service 1-5: Last Service State ↓CD ↓HHA ↓MA
Field Length: 2
Format: Alpha
Description: The contact information for the most recent service submitted to Medicaid for the Medicaid member
(same as Provider 1-5 State).
Service 1-5: Last Zip Code ↓CD ↓HHA ↓MA
Field Length: 9
Format: Numeric
Description: The contact information for the most recent service submitted to Medicaid for the Medicaid member
(same as Provider 1-5 Zip).
Service Date ↓BSD ↑BSU
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The service date is associated with a billing instance and indicates the month during which a member
meets the billing instance criteria.
Editing Logic: This field must conform to the date format listed above and must be the first of the month. Records
submitted with a value that is not the first of the month or records submitted in the incorrect format will be
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rejected. Initial CANs NY Assessments Fees will display the date the CANs was signed and finalized on the Billing
Support Download File and may not be the 1st of the month.
Social Service District Office ↑CU ↓PND ↑PNU Field Length: 1 Format: Alpha (Y/N)
Description: Partners that are the local Social Service District Office.
Start Date ↑CU ↓CD ↓CE
Field Length: 8
Format: MMDDYYY, Numeric
Description: Start Date (either existing or new) of a consent record.
Status ↓PAD ↓ED ↓CF
Field Length: 2 (CD), 20 (ED)
Format: Numeric (01,02,03), Alpha
Description: This field indicates the status of the consent or the segment.
Status Start Date ↓ED
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The Start date of the most recent status.
Status End Date ↓ED
Field Length: 8
Format: MMDDYYYY, Numeric
Description: The end date of the most recent status
Submitted Partner Name ↓PND ↑PNU
Field Length: 100
Format: Alpha Description: The name the Health Home would like to submit on their Partner Network Upload File to call a network partner by.
Substance Abuse Inpatient Stay
↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N/U)
Description: This field is submitted on the Billing Support Upload file to indicate if a member was discharged from
an inpatient stay due to substance abuse within the last year. A value of ‘Y’ means that the member was
discharged from a substance abuse inpatient stay within the past year, a value of ‘N’ means that the member was
not discharged from a substance abuse inpatient stay within the past year, and a value of ‘U’ means that the
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member was discharged from a substance abuse inpatient stay within the past year, but the submitting provider
does not know the member’s discharge date.
Substance Abuse Inpatient Stay Discharge Date ↓BSD ↑BSU
Field Length: 8
Format: MMDDYYYY, Numeric
Description: If a member had an inpatient stay due to Substance Abuse within the last year, then this field collects
the date that member was discharged from that inpatient stay. This field is part of the High, Medium, Low (HML)
Assessment and is one of the variables used to determine a member’s monthly HML rate.
Editing Logic: If Substance Abuse (field #16) in the Billing Support Upload file contains a value of ‘Y’, then Billing
Support Upload Substance Abuse Discharge Date (field #17) must be populated with the date that the member
was discharged from the substance abuse inpatient stay. The submission must be a valid date and must conform
to the date format listed above. If Substance Abuse (field #16) in the Billing Support Upload file contains a value of
‘N’ or ‘U’, then field this field should be blank and the system will ignore any values submitted in Substance Abuse
Discharge Date (field #17).
SUD Active Use/Functional Impairment ↓BSD ↑BSU
Field Length: 1
Format: Alpha (Y/N)
Description: Providers use this field to indicate if a member suffers from a substance abuse related functional
impairment or has a problematic substance abuse issue based on the criteria listed below.
Editing Logic: This field should be populated with a value of ‘Y’ for a member with at least one Indicator A value, at
least one Indicator B value, AND at least one Indicator C value. This field should be populated with a value of ‘N’
for members that do not meet the criteria. If a member has 2 Indicator B values but does not have an Indicator A
or C value, then the member does not meet the criteria and this field must be populated with a value of ‘N’.
Indicator A AND Indicator B AND Indicator C
• Positive Lab test for Opioids, Benzodiazepines, Cocaine, Amphetamines, or Barbiturates OR
• Care manager observation (with supervisory sign-off) of continued use of drugs (including synthetic drugs) or alcohol OR
• MCO report of continued use of drugs or alcohol
• Demonstration of a functional impairment including continued inability to maintain gainful employment OR
• Continued inability to achieve success in school OR
• Documentation from family and/or criminal courts that indicates domestic violence and/or child welfare involvement within the last 120 days OR
• Documentation indicating active Drug court involvement
• The presence of 6 or more Criterion of substance use disorder under DSM-V which must also include pharmacological criteria of tolerance and/or withdrawal.
Suggested Alternate Assignment ↓HHA ↓MA ↓MMD ↑TFA
Field Length: 8
Format: Numeric
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Description: This field is optional. When a provider is rejecting an assignment, the provider can use this field to
suggest another provider for the member (same as Suggested Alternative CMA Assignment).
Suggested CMA MMIS ID ↓MFA ↓HHA ↓CRD ↓MA
Field Length: 8
Format: Numeric
Description: This field is associated with a Suggested CMA that the referring provider selected on the most recent
child referral for the member.
Suggested CMA Name ↓MFA ↓HHA ↓CRD ↓MA
Field Length: 40
Format: Alphanumeric
Description: This field is associated with a Suggested CMA that the referring provider selected on the most recent
child referral for the member.
Suggested HH MMIS ID ↓MFA ↓HHA ↓CRD ↓MA
Field Length: 8
Format: Numeric
Description: This field is associated with a Suggested HH that the referring provider selected on the most recent
child referral for the member.
Suggested HH Name ↓MFA ↓HHA ↓CRD ↓MA
Field Length: 40
Format: Alphanumeric
Description: This field is associated with a Suggested HH that the referring provider selected on the most recent
child referral for the member.
Target Population ↓AD
Field Length: 1
Format: Numeric
Description: Indicates the target population selected on the child HCBS assessment in UAS.
Time ↓CF
Field Length: 8
Format: HH:MM:SS Numeric
Description: The most recent time that the consent record was created or updated.
Transfer Create Date ↓HHA ↓ED ↓CD
Field Length: 8
Format: MMDDYYYY, Numeric
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Description: This date is associated with an assignment with a transfer record type. This date is the date that the
transfer was created within the system (same as Pending Transfer Create Date).
Transfer Comment ↓HHA ↓ED ↓CD
Field Length: 300
Format: Alphanumeric
Description: This is a text field for a comment, if necessary, about the transfer (same as Pending Transfer
Comment).
Transfer Effective Date ↓MAD ↓HHA ↓ED ↓CD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This date is associated with a pending assignment with a transfer record type. If an HH/CMA accepts
a pending assignment with a transfer record type, the system will create a new enrollment segment with the
appropriate HH/CMA with a begin date equal to the Transfer Effective Date (field #9) and will end date the original
enrollment segment one day prior to the Transfer Effective Date (field #9) (same as Pending Transfer Effective
Date).
Transfer Initiator MMIS Provider ID ↓HHA ↓ED ↓CD
Field Length: 8
Format: Numeric
Description: An MMIS Provider ID is a unique identification number assigned to a provider by NYS Medicaid when
the provider enrolls in NYS Medicaid. The Transfer Initiator MMIS ID is populated with the MMIS ID for the
organization that initiated the transfer (same as Pending Transfer Initiator MMIS ID).
Transfer Initiator Organization Name ↓HHA ↓ED ↓CD
Field Length: 40
Format: Alpha
Description: The Transfer Initiator Organization Name is populated with the name for the organization that
initiated the transfer (same as Pending Transfer Initiator Organization Name).
Transfer Reason ↓HHA ↓ED ↓CD
Field Length: 75
Format: Alpha
Description: The Transfer Reason is a dropdown selection the initiating organization selects. The dropdown
selected displays as text on the download files when a there is a pending transfer request (same as Pending
Transfer Reason).
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Transfer Receiver MMIS ID ↓HHA ↓ED ↓CD
Field Length: 8
Format: Numeric
Description: An MMIS Provider ID is a unique identification number assigned to a provider by NYS Medicaid when
the provider enrolls in NYS Medicaid. The Transfer Receiver MMIS ID is populated with the MMIS ID for the
organization that receives the member if the transfer is accepted (same as Pending Transfer Receiver MMIS ID).
Transfer Receiver Organization Name ↓HHA ↓ED ↓CD
Field Length: 40
Format: Alpha
Description: The Transfer Receiver Organization Name is populated with the name for the organization that
receives the member if the transfer is accepted (same as Pending Transfer Receiver Organization Name).
UAS Complexity Assessment ↑BSU ↓BSD
Field Length: 1
Format: Alpha (Y/N/U)
Description: This field indicates if a UAS Complexity Assessment has been completed for an adult member.
Editing Logic: This is a required field on the HML for full HMLS, but does not affect HML rates.
Validation Code ↓BSD
Field Length: 1
Format: Alpha
Description: This field indicates the code for which validation non-billable potential billing instances would trigger
to prevent it from being added to system.
Validation Code Description ↓BSD
Field Length: 1
Format: Alpha
Description: This field describes the codes for which validation non-billable potential BIs would trigger to prevent
it from being added to system.
Void Date ↓BSD
Field Length: 8
Format: MMDDYYYY, Numeric
Description: This field includes the date that a billing instance is voided. It is only populated on voided billing
instances.
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Appendix B: File Error Reason Codes Error Name Error Description
CIN XXXXXXXX is not a valid CIN Invalid CIN Format
No association with member (MMDDYYYY)
Member not associated with user’s organization
No BI for XXXXXXXX as of MMDDYYYY No billable services
No BI for XXXXXXXX as of MMDDYYYY Member status not billable
No billing instance to void (MMDDYYYY) Nothing to void
MMDDYYYY Duplicate billing instance Duplicate Billing Instance
Service Date (MMDDYYYY) not 1st of month
Date of Service not first of month
DB can't be 'N' for non-converting CMA Note: this error message should read DB can’t be ‘Y’ for non-converting CMA
Direct Bill No to Yes
Comment required with 'Other' submission
Comments required when Other selected
Chronic Condition(s) must be selected Chronic Conditions Required
HIV Status field required Is the member HIV positive?
Viral Load required if HIV Status is Y What is the member's viral load?
T-Cell required if HIV Status is Y What is the member's T-Cell count?
Member Housing Status field required Is the member homeless?
HUD Category req'd for homeless member
Does the member meet the HUD Category 1 or HUD Category 2 level of homelessness?
Incarceration field required Was the member incarcerated within the past year?
Release Date req'd if Incarceration is Y When was the member released (enter release date)?
Mental Illness field required Did the member have a recent Inpatient Stay status for mental illness?
Discharge Date req'd if Mental Illness=Y When was the member discharged from the inpatient stay for mental illness?
Substance Abuse field required Did the member have a recent inpatient stay for substance abuse?
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Error Name Error Description
Discharge Date req'd if Substnce Abuse=Y When was the member discharged from inpatient stay for substance abuse (enter the discharge date)?
SUD Active Use/Impairment req'd SUD Active Use/Functional Impairment
AOT member field required Is the member in AOT?
AOT minimum service provided field req'd
Were the minimum required AOT services provided and the caseload requirement met? For dates on or after the configurable date XX/XX/XXXX, the description will be: Were the minimum required AOT services provided and the caseload requirement met?
AOT minimum service provided field req'd
Were the minimum required AOT services provided?
ACT member field req'd if CMA is 'ACT' Is the member in ACT?
ACT minimum service provided field req'd Were the minimum required ACT services provided?
Member qualifies for AH+ field required The member is an impacted adult home member on/after March 2014 and is a class member. Does the member qualify for Adult Home Plus Care Management (refer to Adult Home Plus Attestation)?
Transitioned to community field req'd Has the Adult Home member transitioned to the community?
Cont to qualify for AH+ field req'd Does the member continue to qualify for the Adult Home Plus Care Management?
Interest in transitioning field is req'd Does the member continue to be interested in transitioning?
Core Service Provided is required field Was a core Health Home service provided this month?
Invalid record type format # of characters in fields exceeds limit
Incorrect value provided for field number <field #>
Invalid entry in field
Service Date entered is a future date Service date in the future
R/E Code is not compatible Member’s R/E Code on the service date is not compatible on the service date
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Error Name Error Description
Missing a Completed CANS Assessment CANS Assessment does not exist in Completed status for the member on the segment after the 2nd month of the Enrollment segment or the last CANS Completion Date is more than 6 months (including the month when the CANS was completed) in the past from the month of the segment
Member is not Medicaid eligible Member is not Medicaid eligible on service date; Details
Child in Foster Care field is required Has the child been in Foster Care at any time this month?
Core Service Provided is required field If HH+ Minimum Services Provided = N, then Core Service Provided is required
HUD1 in 6mos req’d if Mbr Housing =N If Member Housing Status = N, then HUD 1 within past 6 months is required
HUD1 in 6mos = blank if Mbr Housing=Y If Member Housing Status = Y, then HUD 1 within past 6 months must be blank.
HUD1 in 6 mos = Y if prior HUD Cat = 1 If prior date of service HUD Category = 1, HUD 1 within past 6 months must be Y.
Date Mbr Housed req'd if HUD1 in 6 mos If HUD 1 within past 6 months = Y, then Date Member Housed is required
Date Mbr Housed must be blank If HUD1 within past 6 months = N, then Date Member Housed must be blank. If Member Housing Status = Y, then Date Member Housed must be blank.
Expanded HH+ Population is req’d field Is the member in the expanded HH+ population?
HH+ Min Services req'd if HH+ pop = Y If Expanded HH+ population = Y, then HH+ Minimum Services Provided is required (for dates of service prior to 5/1/19)
HH+ Min Services = blank if HH+ pop = N If Expanded HH+ population = N, then HH+ Minimum Services Provided must be blank (for dates of service prior to 5/1/19
Mbr D/C from ACT. ACT Mbr field must = N
ACT Member discharged within 6 months
Invalid Princ Prov code for service date Principal Provider Code = AL and member not on Adult Home Class Member table and current billing status = Voided or In Progress Or Principal Provider Code = NH and current billing status = Voided or In Progress, or if the BI does not fall into the rule of the 1st month of NH
Cannot select HCBS only and HCBS
other cannot both be indicated “Children’s HCBS Only” and “Children’s HCBS and other conditions” cannot both be indicated
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Error Name Error Description
Cannot select HCBS only and another CC “Children’s HCBS Only” and “Children’s HCBS and other conditions”
Cannot select only HCBS and other “Children’s HCBS and other conditions” has to be indicated with another Health Home Qualifying Condition
Cannot select Adult HCBS for child “Adult HCBS and other conditions” can only be indicated for a member with Provided Service Type Indicator = Adult Or “Adult HCBS and other conditions” cannot be indicated for a member in HHSC
Cannot select child HCBS for adult “Children’s HCBS Only” cannot be indicated for a member in HHSA Or Children’s HCBS and other conditions cannot be indicated for a member in HHSA
UAS Complexity field required Did the member complete the UAS Complexity High Risk Assessment?
HH+ Min Services req'd if HH+ pop does not = A
If Expanded HH+ population does not = A, then HH+ Minimum Services Provided is required
HH+ Min Services = blank if HH+ pop = A If Expanded HH+ population = A, then HH+ Minimum Services Provided must be blank
Member does not have plan of care Member must have Plan of Care after 60 number of days.
Release Date cannot be in future Incarceration Release Date cannot be in the Future
Release Date cannot be prior to DOB Incarceration Release Date cannot be prior to Member’s Date of Birth
Release Date cannot be prior to 2012 Incarceration Release Date cannot be prior to 1/1/2012
Discharge Date cannot be in future Mental Illness or Physical Health OR Substance Abuse Inpatient Stay Discharge Date cannot be in the Future
Discharge Date cannot be prior to DoB Mental Illness or Physical Health OR Substance Abuse Inpatient Stay Discharge Date cannot be prior to Member’s Date of Birth
Discharge Date cannot be prior to 2012 Mental Illness or Physical Health OR Substance Abuse Inpatient Stay Discharge Date cannot be prior to 1/1/2012
Date Member Housed cannot be in the Future
Date Mbr Housed cannot be in future
Date Mbr Housed cannot be prior to DoB Date Member Housed cannot be prior to Member’s Date of Birth
Date Mbr Housed cannot be prior to 2012 Date Member Housed cannot be prior to 1/1/2012
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Error Name Error Description
Pend Reasons ‘Pended Due to Diligent Search’ and ‘Pend Reason Due to Continued Search Effort’ are not valid pend reasons for outreach segments
Record rejected if the pend reason code ‘05 Pended Due to Diligent Search’ or ‘06 Pend Reason Due to Continued Search Effort’ is used to pend an outreach segment.
When performing the action to pend a pend, the former segment start date cannot equal the new segment start date
Record rejected if the start date of the new segment = the start date of the existing segment when attempting to pend a pended or pending pended segment
INVALID_LENGTH Record rejected for an invalid length of characters in any field
INVALID_RECIP_ID Record rejected for an invalid CIN. This could be a CIN that does not exist or the wrong format of a CIN.
INVALID_PEND_CODE Record rejected for an invalid Pend Code. This would mean a user used a value that does not match any value in the code table.
MEMBER_NOT_IN_PLAN Record rejected because at the time of the upload, the member included in the line is not enrolled with the Plan in MDW.
INVALID_COV_CODE Record rejected because at the time of the upload, the member has an invalid coverage code in MDW. This is applicable to new assignments for members who have participated in the Health Home program before or those that have a history, but are not actively participating in the Health Home program.
INVALID_RE_CODE Record rejected because at the time of the upload, the member has an invalid R/E code in MDW. This is applicable to new assignments for members who have participated in the Health Home program before or those that have a history, but are not actively participating in the Health Home program.
INVALID_HEALTH_HOME_ID Record rejected for an invalid Health Home MMIS ID. This could mean a MMIS ID was entered that does not exist, is in the wrong format, or the health home is suspended or closed.
NO_RELATIONSHIP Record rejected because the Health Home is not contracted with the Managed Care Plan.
EXISTING_SEGMENT Record rejected for an existing segment in the following statuses: Pending Active, Active, Pending Pended, Pended, Pending Closed, Pending Cancelled, or Hiatus.
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Error Name Error Description
DUPLICATE_ACTION Record rejected because the user is attempting to assign a Health Home that has already been assigned. This would not include an MCP user that attempts to pend a pended assignment. Error also indicates that an opt-out record already exists within the same time period of the record attempting to be uploaded.
INVALID_ADDRESS Record rejected for an address that did not meet the system validations.
Invalid_ Reason Opt-out record was rejected du to non-conforming opt-out reasons.
INVALID_SEGMENT_END
Opt-out record was rejected due to the member having an enrollment in any status other then canceled that have effective dates that overlap the opt out signature date OR the member has an outreach segment in any status other then canceled that have effective dates that overlap the opt out signature date and does not have an end date in the month of opt out signature date.
INVALID_OPT-OUT_END
Record was rejected because an Opt-Out End Date is submitted for a member, and the member evidence record does not contain an Opt-Out Signature Date OR the Opt-Out End Date is prior to an Opt-Out Signature Date
SIGNATURE_DATE_REQUIRED The Signature Date is required when: a C-record is submitted OR when a D-record is submitted.
END_DATE_REQUIRED
The Opt-Out End Date is required when a E-record is submitted. If an End Date is not submitted, the record will be rejected.
NO_RECORD_EXISTS
An existing record must exist in non-canceled status for the submission of a D-record. If a D-record is submitted, and a record does not exist for that member in the restriction table, then the submission will be rejected
INVALID_PHONE Record rejected for a phone that did not meet the system validations.
INVALID_STATUS Record rejected because the user is trying to perform an action that is not allowed on the due to the existing assignment’s status. For example, a user cannot pend an active assignment.
INVALID_DATA_COMBO Only Health Home MMIS Provider ID or Pend Reason Code are required. Both cannot be entered for the same member
MBR_UNDER_21 Members under 21 years of age must be referred into the Health Home program online via Children’s Referral Portal
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Error Name Error Description
Invalid_Format Record rejected for an invalid format in any field
INVALID_NPI_FORMAT NPI must contain 10 numeric characters
INVALID_DATE_FORMAT The date must be inputted as MMDDYYYY
Invalid Princ Prov code for service date Principal Provider Code = AL and member not on Adult Home Class Member table and current billing status = Voided or In Progress
Invalid Princ Prov code for service date Principal Provider Code = NH and current billing status = Voided or In Progress
HH+ Min Services req'd if HH+ pop does not = A
If Expanded HH+ population does not = A, then HH+ Minimum Services Provided is required
HH+ Min Services = blank if HH+ pop = A If Expanded HH+ population = A, then HH+ Minimum Services Provided must be blank
POC Invalid Field Record rejected because Record type is ‘P’, or ‘D’ and values were entered into fields other than Record Type, Member ID, and Plan of Care Date
POC Date Required Record rejected because Record Type is ‘P’ or ‘D’ and Plan of Care Date not entered
Consent Record Not POC Record rejected because Record type is ‘C’, ‘W’, or ‘M’ and a value was entered into the Plan of Care Date field.
Plan of Care may only be created by DOH and Health Homes
Record rejected because Record type is ‘P’ and organization is not DOH or a HH
TEMPORARY_CONSENT Record rejected because the value ‘06’ was entered into the New Consent Type field and the user is not DOH
SYSTEM_CONSENTER Record rejected because the value ‘04’ was entered into the Consenter field when the user is not DOH
MEMBER_AGE_CONSENTER
Record rejected because the value of ‘01’, ‘02’ or ‘05’ was entered into the Consenter field when the member is not at least 18 years of age at any time during the month of the consent start date> 18 years of age.
Start Date cannot be prior to 1/1/2012 Record rejected because the start date is prior to 1/1/2012,
Start Date cannot be >180 days in the Future
Record rejected because the start date is more than 180 days in the future.
End Date cannot be >180 days in the Future
Record rejected because the end date is more than 180 days in the future.
START_DATE_BEFORE_DOB Record rejected because the start date cannot be before date of birth.
POC Start Date cannot be prior to the member DOB
Record rejected because the POC start date cannot be prior to date of birth.
POC Start Date cannot be prior to 1/1/2012
Record rejected because the POC start date cannot be prior to 1/1/2012.
Pend Start Date cannot be >180 days in the Future
Record rejected because the pend start date cannot be greater than 180 days in the future.
Effective Date cannot be > 180 days in the future
Record rejected because the effective date cannot be greater than 180 days in the future.
SIGNATURE_DATE_BEFORE_DOB Record rejected because the signature date is before date of birth.
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Error Name Error Description
SIGNATURE _DATE_BEFORE_1-1-2012 Record rejected because the signature date is before 1/1/2012.
FUTURE_ SIGNATURE _DATE_>180 Record rejected because signature date cannot be greater than 180 days in the future.
FUTURE_END_DATE_>180 Record rejected beause end date cannot be greater than 180 days in the future.
Start Date cannot be prior to Children's HH Program Start Date
Record rejected because the start date cannot be prior to the Children’s HH Program start date.
From Date cannot be prior to 1/1/2012 Record rejected because the from date cannot be prior to 1/1/2012.
From Date cannot be > 180 days in the future
Record rejected because the from date cannot be more than 180 days in the future.
To Date cannot be >180 days in the Future
Record rejected because the to date cannot be more than 180 days in the future.
001 CIN Format is invalid CIN format is AA11111A
002 As of <MMDDYYYY> the member is not eligible for Medicaid
003 The DOB entered does not match the DOB in the Medicaid system
004 The gender entered does not match the gender in the Medicaid system
006 Member is not assigned to the provider
011 The Begin Date entered is not the 1st of the month
012 The end date entered is not the last day of the month
013 The end date entered is prior to the segment begin date <MMDDYYYY>
014 The Outreach Enrollment code entered must be O or E
015 Valid gender codes are M or F
016 Invalid Record Type. Must be S, R, E, N for assign and C, A, M, P, D for seg recs
017 Valid referral indicators are R NULL or T
021 The Care Management Agency MMIS ID entered <XXXXXXXX> is invalid
022 The Health Home MMIS ID entered <XXXXXXXX> is invalid
025 Segment does not follow record type format
026 Overlapping segment w HH MMIS ID <12345678> <MMDDYYYY> to <MMDDYYYY>
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Error Name Error Description
028 Original record does not exist for Change or Delete operation
029 A member can only have 3 months of active outreach in 6 months
030 The segment begin date cannot be prior to 01012012
031 Segment begin dates cannot be in the future
034 Pioneer ACO member, refer to/contact the Pioneer ACO HH (BAHN)
035 Assignment must be pending
037 Invalid End Date Reason Code
038 Invalid Rejection Reason Code
039 Invalid Coverage Code found
040 Invalid RE Code found
042 No relationship exists between HH and CMA
044 No Valid Record Found
046 Pend Start Date is required
047 Segment Begin Date is required
049 Pend Start Date is before Segment Start Date
051 Invalid Date Format must be ‘MMDDYYYY”
052 R code is required when segment start is prior to assignment
053 End Date Reason required when End Date populated
054 End HH Assignment required when End Date populated
055 Valid End HH Assignment values are Y N or NULL
056 End HH Assignment should not be populated unless end date is populated
057 End Date Reason should not be populated unless end date is populated
058 The segment falls outside of the HH’s effective dates
059 The segment falls outside of the CMA’s effective dates
060 Member has a pended assignment with <MCP>
061 The End Date entered is prior to the Pend Start Date
062 Invalid File Action
063 Adult / Child Services value is required for this member
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Error Name Error Description
064 The Provider Type for Suggested Alternate Assignment is invalid
064 Consent to Enroll is required for the full segment period
065 Suggested Alternate Assignment is required
065 Cannot Provide Child Services prior to Children’s Program Start Date
065 Cannot Provide Child Services prior to Children’s Program Start Date
066 Member under 21, use Child HH Referral Portal
067 Invalid Value for Adult or Child Services Provided Indicator
069 No relationship exists between HH and MCP
075 HH adult/child designated indicator does not match
076 Member is on the Exclusion Table
077 CMA Provider MMIS ID is required
078 Rejection Reason required
079 End Reason is required
080 HH Provider MMIS ID is required
081 End HH Assignment must contain Y/N
082 End HH must be Y for Record Type E and no CMA MMIS ID when HH user
083 End HH must be N for Record Type S when HH/CMA user
084 End HH must be N for Record Type N when HH or VFCA user
086 CMA is already assigned
087 HH is already assigned
088 Invalid Pend Date Reason Code
089 Record contains special characters which is not allowed
090 Record contains fewer fields than required
091 Record contains more fields than allowed
092 Only Active HH assignments can be Ended by a HH
093 Only Pending CMA assignment can be Ended by a HH
094 Only Active CMA assignment can be Ended by a CMA or HH
095 Only Pending or Active HH assignments can be Ended by a VFCA
096 Member ID required
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Error Name Error Description
097 User’s organization must have a pending/active assignment
098 Invalid Record Type for non-VFCA CMA
100 Unable to Pend a segment in the current status
101 Comments are required when Reject or End Reason is Other
102 Pend Reason Codes 05 and 06 are not valid for outreach segments
103 Pended segments cannot be pended with same start date
104 The End Date Reason Code <xx> cannot be used after <mm/dd/yyyy>
105 Opt-out Signature must be Prior to Submission Date
106 End Reason 45 permitted for Diligent Search OR Continued Search Effort
107 The Pend Reason Code <xx> cannot be used after <mm/dd/yyyy>
110 Cannot create Pended Segment using M-record
111 Record exists in current status, no modification requested
112 Member enrolled in ACT, end date must be on or before xx/xx/xxxx
113 Member enrolled in ACT from xx/xx/xxxx to xx/xx/xxxx
114 Consent can only be created for Referrals
115 Consent cannot be modified via tracking file
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Appendix C: Segment Pend Reason Codes The reason codes listed below explain why a user would pend a member’s outreach or enrollment segment. These
codes are used in the Pend Reason Code field on the Billing Support Download file, the Pend Reason Code field on
the Tracking File Segment Records file, and the Segment Pend Reason Code field on the Enrollment Download File.
Segment Pend Date Reason Codes and Descriptions valid for segments with a
pend start date on or after 7/1/19
Code Code Description
01 Pended due to Inpatient Stay
02 Pended due to Incarceration
03 Pended due to Hiatus
04 Pended due to Other
05 Pended due to Diligent Search Efforts
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Appendix D: Segment End Date Reason Codes The reason codes listed below explain why a user would end a member’s outreach or enrollment segment. These
codes are used in the Disenrollment Reason Code field on the Enrollment Download file, the End Date
Reason field on the My Members Download file, and the Disenrollment Reason Code field on the Tracking File
Segment Records.
For instance, the system will allow a segment with a start date of 5/1/2012 and an end date of 11/30/2018 to be
closed using code 42: ‘Program not compatible’. However, the system will not allow a segment with a start date
of 5/1/2012 and an end date of 10/31/2018 to be closed using code 42: ‘Program not compatible’.
Additional information regarding when it is appropriate to use each segment end date reason code can be found
on the MAPP HHTS website:
i) https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/mapp
/docs/mapp_segment_end_date_code_crosswalk.pdf
ii) https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/mapp
/docs/mapp_segment_end_date_code_guidance.pdf
Segment End Date Reason Codes and Descriptions valid for segments with end
dates on or after 10/31/2018
Code Code Description Outreach,
Enrollment or Both
01 Transferred to another HH Both
02 Individual opted-out (pre-consent only) Outreach
03 Transferred to another CMA Both
04 Individual deceased Both
05 Individual has a new CIN Both
07 Closed for Health, welfare and safety concerns for member and/or staff Enrollment
09 Individual moved out of state Both
11 Individual incarcerated Both
13 Individual is in an inpatient facility Both
14 Enrolled Health Home member disengaged from Care Management services Enrollment
16 Inability to contact/locate individual Outreach
18 Member interested in HH at a future date Outreach
19 Individual doesn’t meet HH eligibility/appropriateness criteria Both
21 Member has graduated from HH program Enrollment
24 Individual is not/no longer eligible for Medicaid Both
25 Individual moved from Outreach to Enrollment Outreach
28 Health Home change MMIS Provider ID Both
29 Member withdrew consent to enroll Enrollment
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Code Code Description Outreach,
Enrollment or Both
32 Provider closed Both
33 Merger Both
38 Active to Closed (system generated) Outreach
41 Coverage not compatible Both
42 Program not compatible Both
43 Individual moved between HHSC and HHSA Both
44 Segment Correction Enrollment
45 Member Re-engaged Enrollment*
98 Invalid end date reason at conversion (system generated) Both
• *End reason code 45 is only valid for segments that have been pended for continued search or
diligent search efforts
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Appendix E: Assignment Rejection Codes The reason codes listed below explain why a HH or CMA would reject an assignment, referral or transfer made to
them.
These codes are used in the Assignment Rejection Reason Code field on the Past Assignments Download file and
the Rejection Reason field on the Tracking File Assignment Records file.
Code Code Description
01 Not a suitable assignment
02 Member moved out of service county
03 Member moved out of state
04 Member not eligible
05 Member incarcerated
06 Member deceased
07 Member inpatient
08 Referred to another Health Home
09 Other
10 At capacity
11 Provider linkages not available
12 Member's address outside of service area
13 No resources speak member language
14 Created in error
15 Referral Not Appropriate
16 Approved by the LDSS to change VFCA (effective on or after 12/1/16)
97 Assignment rejected in pre-MAPP HHTS
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Appendix F: Assignment Pend Reason Codes The reason codes listed below explain why an MCP would pend a member’s assignment or referral. These codes
are used in the Pend Reason Code field on the Error Report: Managed Care Plan Final Health Home Assignment file
and the Pend Reason Code field on the Managed Care Plan Final Health Home Assignment file.
Assignments that are pended by the MCP may or may not be eligible to be purged from the Assignment file based
on inactivity. Included in the below table is a column that describes how long a member with a specific pended
assignment must sit in activity before it is purged from the assignment file. The act of pending a member or change
a pend reason is counted as an ‘action’ and restarts the inactivity clock.
Code Code Description Purge Inactivity Period
01 Receiving care management services 90 days
02 Member enrolled in different program Never purged
03 Alternate HH needs to be identified 60 days
04 Awaiting contract with Health Home 60 days
05 Referral Not Appropriate Never purged
06 Other Never purged
07 Follow up 1 month 45 days
08 Follow up 3 months 90 days
09 Follow up 6 months 180 days
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Appendix G: Assignment End Reason Codes The reason codes listed below explain why an HH would end a member’s assignment to the HH or why a CMA
would end a member’s assignment with the CMA. These codes are used in the Assignment End Date Reason
Code field on the Past Assignments Download file and the End Date Reason field on the Tracking File Assignment
Records file.
Code Accepted Language Values Source Comments
01 Created in error Provider Input
02 Member deceased Provider Input
03 Member has a new CIN Provider Input
04 Member moved out of service county
Provider Input
05 Member moved out of state Provider Input
06 Member not eligible Provider Input
07 Member incarcerated Provider Input
08 Member inpatient Provider Input
09 Member does not meet HH criteria
Provider Input
10 Member transitioned to a FIDA Program
Provider Input
11 Member is no longer Medicaid eligible
Provider Input
12 Other Provider Input If this code is selected, explanation of "Other" reason is required
14 Changed HH System generated when system ends an HH Assignment because MCP/DOH created a new HH Assignment for a member that had an existing HH assignment
15 Changed CMA System generated when system ends a CMA Assignment because the Health Home created a new CMA Assignment for a member that had an existing CMA assignment
16 Moved to outreach with different CMA
System generated when system ends a CMA Assignment because the Health Home created an outreach segment for member with a CMA that was different than the CMA that the HH assigned the member to.
17 Moved to enrollment with different CMA
System generated when system ends a CMA Assignment because the Health Home created an enrollment segment for member with a CMA that was different than the CMA that the HH assigned the member to.
18 Outreach ended with no enrollment
System generated when an HH/CMA assignment ends because the member cycled out of outreach/outreach hiatus without being enrolled
19 Enrollment ended System generated when an HH/CMA assignment ends because an enrolled member's segment ended with the HH/CMA.
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Code Accepted Language Values Source Comments
20 No Medicaid Coverage System generated when MCP/HH/CMA assignment ends because the member is no longer Medicaid Eligible
21 Invalid Coverage Code System generated when MCP/HH/CMA assignment ends because the member has a coverage code that is incompatible with the Health Home program (see Appendix H: Reference and Contacts for link to the HH Coverage Code Compatibility document on the HH website)
22 Invalid R/E Code System generated when MCP/HH/CMA assignment ends because the member has a recipient R/E code that is incompatible with the Health Home program (see Appendix H: Reference and Contacts for link to the HH Recipient R/E Compatibility document on the HH website)
23 TCM/HH – ACT Claim Exists System generated when MCP/HH/CMA assignment ends because of a recent TCM/HH/ACT claim in the system (this indicates that the member has a connection to a Health Home, even though the member is not yet in outreach or enrollment in the system)
24 Adult Home Member System generated when HH/CMA assignment ends because a member is an Adult Home member
25 Changed Recommended HH System generated when the DOH HH recommendation sent to a member's MCP by DOH is replaced with a new DOH HH recommendation
26 Switched from Mainstream MCP to FFS
System generated when HH/CMA assignment ends because the member moved from MCP to FFS. Member's HH assignment switched to the HH that DOH assigned the member to based on member claims and encounters and HHs' Partner Network lists
27 Switched from Non-Mainstream MCP to FFS
System generated when HH/CMA assignment ends because the member moved from MCP to FFS. Member's HH assignment switched to the HH that DOH assigned the member to based on member claims and encounters and HHs' Partner Network lists
28 Switched Mainstream MCPs System generated when HH/CMA assignment ends because the member moved from one MCP to another MCP. Any assignments made while member was with the first MCP are ended and new MCP now responsible for assigning member to an HH.
29 Switched Non-Mainstream MCPs
System generated
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Code Accepted Language Values Source Comments
30 Switched Mainstream to N-Mainstream
System generated
31 Switched Non-Mainstream to Mainstream
System generated when HH/CMA assignment ends because the member moved from to a Mainstream MCP. Any assignments made while member was with non-mainstream MCP are ended and new MCP now responsible for assigning member to an HH.
32 Switched from FFS to Mainstream MCP
System generated when HH/CMA assignment ends because the member moved from FFS to MCP. Any assignments made while member was FFS are ended and new MCP now responsible for assigning member to an HH.
33 Switched from FFS to Non-Mainstream MCP
System generated
34 Member switched from FFS to FFS
System generated
35 Provider Changed ID System generated when an assignment is ended because an HH changed their MMIS Provider ID
36 Member deceased System generated If NYS Medicaid reports to the system that a member has a date of death according to NYS Medicaid, then the system end dates any assignments in the system with this reason code. If a member with a date of death from NYS Medicaid has a segment, the system does not end date the segment.
37 Segment Created System generated when the system ends an assignment due to the creation of a segment.
38 Pended by MCP System generated Effective on or after 12/1/16.
39 Not in HH eligible pop as of MM/DD/YYYY
System generated When a member’s MCP/HH/CMA assignment ends because they are no longer part of the HH eligible population when DOH updates the HH eligible population table as of a certain date.
40 Member No Longer Pioneer ACO
System generated When a member’s HH/CMA assignment ends because they are no longer part of the refreshed Pioneer ACO population table as of a certain date.
41 Pioneer ACO Member System generated When a member’s HH/CMA assignment ends because they are now part of the refreshed Pioneer ACO population table as of a certain date.
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Code Accepted Language Values Source Comments
42 Risk Score below threshold System generated When a member’s MCP/HH/CMA assignment ends because their risk score is below the DOH established threshold.
43 Member on Exclusion Table System generated When a member’s MCP/HH/CMA assignment ends because they meet exclusionary criteria that is provided to DOH so that they are no longer prioritized for HH assignment.
44 Member case has been renewed per the assignment file
System generated
45 Member is listed on the Adult Home Table
System generated
46 Closure System generated When a HH/CMA assignment ends as a result of a HH/CMA provider being closed in the system.
47 Relationship with Member Ended
System generated
48 Member Under 21 System generated
49 Assignment Purged Due to
Inactivity
System generated
50 Assignment Ended due to
Member Opt-out
System generated
51 Child Re-Referred System generated
99 Member removed from
assignment file
System generated
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Appendix H: High, Medium, Low (HML) Assessment Codes
The Billing Support Upload file accepts BIs for adults and children. Adult BIs ask a larger number of questions.
Based on the member’s population, level of services and responses to the questions the adult member receives a
HH rate. A child’s BI asks few questions and utilizes the Cans-NY assessment to determine the correct acuity level
to bill at. For a current list of both adult and child rates please see:
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/billing/docs/current_hh_rat
es.pdf
The following codes are used in the Billing Support Upload file. The majority of the below fields pertain only to
adult HML assessments, although some questions, such as Pre-Conditions of member pertain to both adult and
child questionnaires.
Field Description Code Code Description
HIV T-Cell Count 0 NA
HIV T-Cell Count 1 Unknown
HIV T-Cell Count 5 >200 (this code is only applicable to service dates on or after 12/1/16)
HIV T-Cell Count 6 <=200 (this code is only applicable to service dates on or after 12/1/16)
HIV Viral Load 0 NA
HIV Viral Load 1 Unknown
HIV Viral Load 2 <200
HIV Viral Load 3 200-400
HIV Viral Load 4 >400
HUD CODES 1 Meets HUD Category 1: Literally Homeless definition
HUD CODES 2 Meets HUD Category 2: Imminent Risk of Homelessness definition
Pre-Conditions of member 02 Mental Health
Pre-Conditions of member 04 Substance Abuse
Pre-Conditions of member 06 Asthma
Pre-Conditions of member 08 Diabetes
Pre-Conditions of member 10 Heart Disease
Pre-Conditions of member 12 Overweight
Pre-Conditions of member 14 HIV/AIDS
Pre-Conditions of member 16 Other
Pre-Conditions of member 18 Complex Trauma (under 21 years of age)
Pre-Conditions of member 20 SED/SMI (this code is only applicable to service dates on or after 7/1/18)
Pre-Conditions of member 22 One or more DD conditions (this code is only applicable to service dates on or after 7/1/18)
Pre-Conditions of member 24 Children’s HCBS only (this code is only applicable to service dates on or after 1/1/19)
Pre-Conditions of member 26 Children’s HCBS and other conditions (this code is only applicable to service dates on or after 1/1/19)
Pre-Conditions of member 28 Adult HCBS and other conditions (this code is only applicable to service dates on or after 1/1/19)
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Field Description Code Code Description
Billing Instance Type O Outreach
Billing Instance Type E Enrollment
Billing Instance Type F CANS NY Assessment Fee
Mental Illness U
Member was discharged from a mental illness inpatient stay within the past year, but submitting provider does not know discharge date (this code is applicable to service dates before or after 5/1/18)
Mental Illness M Member was discharged from an inpatient stay due to mental illness within the past year (for service dates on or after 5/1/18)
Mental Illness P Member was discharged from an inpatient stay due to physical health within the past year (for service dates on or after 5/1/18)
Mental Illness N
Member was not discharged from a mental illness OR physical health inpatient stay within the past year (for service dates on and after 5/1/18)
Mental Illness V
Member was discharged from a physical health inpatient stay within the past year, but submitting provider does not know discharge date (for service dates on or after 5/1/18)
Expanded HH+ population N Member is not part of the expanded HH+ population
Expanded HH+ population A No (for service dates on or after 5/1/19)
Expanded HH+ population B Yes. HH+ HIV – Virally Unsuppressed (for service dates on or after 5/1/19)
Expanded HH+ population C Yes HH+ HIV – SMI and 3+ in-patient hospitalizations in the last year (for service dates on or after 5/1/19)
Expanded HH+ Population D Yes. HH+ HIV – SMI and 4+ ED visits in the last year (for service dates on or after 5/1/19)
Expanded HH+ Population E Yes. HH+ HIV – SMI and homelessness (HUD 1 definition) (for service dates on or after 5/1/19)
Expanded HH+ population F Yes. HH+ HIV – Injection Drug Use and 3+ in-patient hospitalizations within the last year (for service dates on or after 5/1/19)
Expanded HH+ population G Yes. HH+ HIV – Injection Drug Use and 4+ Ed visits within the last 12 months (for service dates on or after 5/1/19)
Expanded HH+ Population H Yes. HH+ HIV – Injection Drug use and homelessness (for service dates on or after 5/1/19)
Expanded HH+ population I Yes. HH+ HIV – Clinical Discretion MCP (for service dates on or after 5/1/19)
Expanded HH+ population J Yes. HH+ HIV Clinical Discretion Medical Providers (for service dates on or after 5/1/19)
Expanded HH+ Population K Yes. HH+ SMI – ACT step down (for service dates on or after 5/1/19)
Expanded HH+ population L Yes. HH+ SMI – Enhanced Service Package/Voluntary Agreement (for service dates on or after 5/1/19)
Expanded HH+ population M Yes. HH+ SMI – Expired AOT order within past year (for service dates on or after 5/1/19)
Expanded HH+ Population N Yes. HH+ SMI – Homelessness (HUD 1 definition) (for service dates on or after 5/1/19)
Expanded HH+ population O Yes. HH+ SMI – Criminal justice involvement (for service dates on or after 5/1/19)
Expanded HH+ population P Yes. HH+ SMI – Discharged from State PC (for service dates on or after 5/1/19)
Expanded HH+ Population Q Yes. HH+ SMI – CNYPC Release (for service dates on or after 5/1/19)
Expanded HH+ population R Yes. HH_ SMI – Ineffectively engaged in care (no outpatient 2/ 2+ psychiatric hospitalizations) (for service dates on or after 5/1/19)
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Field Description Code Code Description
Expanded HH+ Population S
Yes. HH+ SMI – Yes. HH+ SMI – ineffectively engaged in case (no outpatient w/ 3+ psychiatric ED visits) (for service dates on or after 5/1/19)
Expanded HH+ population T Yes. HH+ SMI – 3+ psychiatric inpatient hospitalizations in past year (for service dates on or after 5/1/19)
Expanded HH+ population U Yes. HH+ SMI – 4+ psychiatric ED visits in past year (for service dates on or after 5/1/19)
Expanded HH+ Population V Yes. HH+ SMI – 3+ medical inpatient hospitalizations in past year w/ dx of Schizophrenia or Bipolar (for service dates on or after 5/1/19)
Expanded HH+ Population W Yes. HH+ SMI – Clinical Discretion SPOA (for service dates on or after 5/1/19)
Expanded HH+ population X Yes. HH+ SMI – Clinical Discretion MCP (for service dates on or after 5/1/19)
UAS Complexity Assessment N UAS complexity Assessment has not been performed on the member (for DOS 1/1/19 and after)
UAS Complexity Assessment Y UAS complexity Assessment has been performed on the member (for DOS 1/1/19 and after)
UAS Complexity Assessment U Unknown if UAS complexity Assessment has been performed on the member (for DOS 1/1/19 and after)
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Appendix I: Tracking File Record Type Codes The record type codes listed below are submitted by either HHs or CMAs to indicate to the system the type of
information that the user is submitting on the record. These codes also indicate to the system what type of format
the system should expect for that record. For example, when a record is submitted with a value of ‘D’ in the
Record Type field, the system knows to expect a delete record containing 17 characters.
These codes are used in the Record Type fields on the Tracking File Assignment Records, Tracking File Segments
Record, Tracking File Delete Record, and the Tracking File Error Report files.
Code Code Description
Record submitted
by
Tracking File Segment Records
Tracking File Assignment
Records
Tracking File Delete
Record
Tracking File Error
Report
S Accept Assignment HH/CMA X X
R Reject Assignment HH/CMA X X
E End Assignment HH/CMA X X
N New Assignment HH only X X
D
Delete Record/Reject Transfer HH/CMA X X
C
Create Segment/Accept Transfer HH/CMA X X
A Accept Segment HH only X X
M Modify Segment HH/CMA X X
P Pend Segment HH/CMA X X
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Appendix J: Determining the Billing Entity
Effective 7/1/2018, Health Home services provided to members enrolled in mainstream (HMO, HARP,
SNP, PHSP) managed care plans will be paid by the members’ managed care plans. Health Homes will
continue to bill NYS Medicaid directly for Health Home services provided to fee for services members
and members enrolled in non-mainstream managed care plans (managed care plan product lines not
listed above i.e., MLTC). As part of release 3.3, the Payor field was introduced to the Billing Support
Download file to indicate the appropriate payor for a member month: ‘P’ for members enrolled in a
mainstream plan or ‘F’ for members enrolled in a non-mainstream plan and fee for service members.
For Health Home service dates on or after 12/1/2016 through 6/30/18, Health Homes bill Medicaid
directly for all providers.
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Appendix K: MCP Final H Assignment File Accepted Values The following values are accepted on the MCP Final Assignment File and display on the HH Assignment File.
Field Description Code Code Description
Plan Provided Member Language Arabic
Plan Provided Member Language Haitian-Creole
Plan Provided Member Language Polish
Plan Provided Member Language English
Plan Provided Member Language Cambodian (Khmer)
Plan Provided Member Language Vietnamese
Plan Provided Member Language Japanese
Plan Provided Member Language Russian
Plan Provided Member Language Navajo
Plan Provided Member Language Apache
Plan Provided Member Language Traditional Chinese
Plan Provided Member Language Simplified Chinese
Plan Provided Member Language Brazilian Portuguese
Plan Provided Member Language Korean
Plan Provided Member Language German
Plan Provided Member Language Tagalog
Plan Provided Member Language Other
Plan Provided Member Language Danish
Plan Provided Member Language Finnish
Plan Provided Member Language Irish
Plan Provided Member Language French
Plan Provided Member Language Spanish
Plan Provided Member Language Italian
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Field Description Code Code Description
Plan Provided Member Language American Sign
Plan Provided Member Language Lao
Plan Provided Member Language Cantonese
Engagement-Optimization A Warm Hand-off
Engagement-Optimization B Direct Enrollment
Engagement-Optimization C Consent Signed
MCP Determined Eligibility 04 Substance Abuse
MCP Determined Eligibility 06 Asthma
MCP Determined Eligibility 08 Diabetes
MCP Determined Eligibility 10 Heart Disease
MCP Determined Eligibility 12 Overweight
MCP Determined Eligibility 14 HIV/AIDs
MCP Determined Eligibility 16 Other
MCP Determined Eligibility 18 Complex Trauma (under 21 years of age)
MCP Determined Eligibility 20 SED/SMI
MCP Determined Eligibility 22 One or more DD conditions
MCP Determined Eligibility 24 Children’s HCBS only
MCP Determined Eligibility 26 Children’s HCBS and other conditions
MCP Determined Eligibility 28 Adult HCBS and other conditions
MCP Determined Eligibility 30 Mental Health non-SMI/SED
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Appendix L: Reference and Contacts The purpose of this appendix is to provide information on the NYS Medicaid program and to provide helpful links
and contact information for Health Home providers.
1) If a member’s personal information that is populated within this system by NYS Medicaid (e.g. date of birth,
name, gender) is incorrect, then the member must correct that information directly with NYS Medicaid. Once
this information is updated, it can take up to a week for that corrected information to be reflected within the
MAPP HHTS. Depending on where the member’s Medicaid case was opened, the member must either update
this information through their local department of social services or through the Marketplace.
a) If a member needs to update their information, a provider should view the member’s County/District
Code through MEVS to determine how the member should update their NYS Medicaid information.
i) If the member’s county code is 78, then that indicates that the member enrolled in NYS Medicaid
through the Marketplace and that their case is open with the Marketplace. If a member with county
code 78 needs to update personal information, the member can update it online themselves OR the
member can call the Marketplace at 1-855-355-5777. Marketplace representative should be able to
assist them and make any changes necessary.
ii) If the member’s County Code is not 78, then the member’s case is open at their local department of
Social Services. To correct personal information, the member can either call their local department of
social services or walk in and speak to someone regarding correcting their personal information.
b) The member may need to provide proof to either Social Services or the Marketplace (i.e., birth certificate,
social security card, driver’s license, etc.) to officially update their personal information with NYS
Medicaid.
2) The Health Home website
a) http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/
3) Health Homes Provider Manual: Billing Policy and Guidance
a) https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/policy/do
cs/hh_provider_manual_v2019-02.pdf
4) Health Home Program Policy and Standards Website
a) https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/policy/index.htm
5) Health Home Program Email webform link (please select most appropriate subject when submitting an email)
a) https://apps.health.ny.gov/pubdoh/health_care/medicaid/program/medicaid_health_homes/emailHealt
hHome.action
6) Health Home Serving Children email address: [email protected]
7) Health Home Program Provider Policy line: (518) 473-5569
8) Resources for determining if a member is eligible/appropriate for the Health Home Program:
a) Eligibility Criteria for HH Services: Chronic Conditions
i) http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/09-23-
2014_eligibility_criteria_hh_services.pdf
b) Eligibility Requirements: Identifying Potential Members for HH Services
i) http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/09-23-
2014_hh_eligibility_policy.pdf
c) Coverage Code Compatibility with HH Program
i) https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/hh_cover
age_codes.pdf
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d) Recipient R/E Compatibility with HH Program
i) https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/restrictio
n_exception_codes.pdf
9) For questions about Health Home claims or issues with submitting Health Home claims:
a) Information on working through denied Health Home claims
i) http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/docs/informatio
n_on_denied_claims.pdf
ii) If the document above does not answer your question, call GDIT (General Dynamics Information
Technology)at: 1-800-343-9000
b) eMedNY Provider Quick Reference Guide
i) https://www.emedny.org/contacts/telephone%20quick%20reference.pdf
c) eMedNY NYS Electronic Medicaid System Remittance Advice Guideline document
i) https://www.emedny.org/providermanuals/allproviders/general_remittance_guidelines.pdf
d) eMedNY Payment cycle calendar
i) https://www.emedny.org/hipaa/news/PDFS/CYCLE_CALENDAR.pdf
10) Please contact MAPP Customer Care Center (email [email protected] or phone (518) 649-
4335) to request information on accessing existing MAPP HHTS training documents, web-based trainings, or to
participate in an instructor led webinar based training.
11) UAS–NY Support Desk via email at [email protected] or by telephone at 518–408–1021
12) Managed Care Plan Contacts for Health Homes and Care Management Agencies
https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/managed_care/mc_hh_
contacts.htm
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Appendix M: Consent File Codes Listed below are the codes used within the Consent Files. Also, below is a link to the Health Homes
Serving Children Consent Process, Forms and Guidance power point presentation that was presented
on August 17, 2016.
Field Description Code Code Description
Record Type C Create Consent
Record Type M Modify Consent
Record Type W Withdraw Consent
Record Type P Create Plan of Care
Record Type D Delete Plan of Care
Consenter 01 Parent
Consenter 02 Guardian
Consenter 03 Legally Authorized Representative
Consenter 04 Member/Self – Individual is 18 years of age or older
Consenter 05 Individual is under 18 years old, but is a parent, or is pregnant, or is married
Consenter 06 System (Not for use by HH or CMA)
Consent Type 01 Consent to Enroll
Consent Type 02 Consent to Share Information
Consent Type 03 Consent to Share Information (Protected Services)
Consent Type 04 Adult Consent Date Needed (Not for use by HH or CMA)
Status 01 Active
Status 02 Withdrawn
Status 03 Ended
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Appendix N: Program Participation File Codes Listed below are the codes used within the Program Participation Files.
Field Description Code Code Description
Record Type C Create
Record Type E End
Record Type D Delete
Opt-out
Reason
01 Member not interested: No Follow-up
Opt-out
Reason
02 Member not interested: follow-up in three months
Opt-out
Reason
03 Member not interested: follow-up in six months
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Appendix O: Transfer Reason Codes Transfer Reason Codes are selected on the screen when creating a transfer request but can be viewed
on the Health Home Assignment Download, CIN Search Download, and Enrollment File Download when
providers utilize these files for certain members that have pending transfers.
Code Code Description
1 Member moved out of service county
2 At Capacity
3 Appropriate provider linkages to best meet the member’s needs not available
4 The member’s address is outside of the service area
5 No resources that speak the member’s primary language
6 Other
7 Member requested transfer
Formatted: Strikethrough
Formatted Table
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Appendix P: Billing Instance Validation Codes Validation codes appear on the Billing Support Download File when a Potential Billing Instance would be
prevented from being added to the system. If a Potential Billing Instance fails more than one validation
the system will populate the first validation detected based on the processing order of operations
outlined below. For example, if the member is Medicaid ineligible and does not have a valid Plan of
Care, the validation code associated with that Potential BI would be E and not J.
Validation Code
Order of Operation Validation Description
A 1 PR02: Pended due to Incarceration
B 2 PR03: Pended due to Hiatus
C 3 PR04: Pended due to Other
D 4 PR06: Pended due to Continued Search Effort
E 5 Cannot create assessment for Medicaid Ineligible members
F 6 Invalid Coverage Code
G 7 Member’s R/E Code on the service date is not compatible
H 8 Adding a billing instance that has a Principal Provider Code = AL
I 9 Adding a billing instance that is voided and has a Principal Provider Code = NH
J 10 Does not have Plan of Care